Does the Use of the "Proseek(®) Multiplex Inflammation I Panel" Demonstrate a Difference in Local and Systemic Immune Responses in Endometriosis Patients with or without Deep-Infiltrating Lesions?

Association Between Circulating Cytokines and Endometriosis: A Mendelian Randomization Study

Existing evidence shows the importance of circulating cytokines in studying female reproductive system dysfunction. Endometriosis (EM) is thought to be associated with multiple immune cytokines, but its causality has not been proven. Utilising Genome-Wide Association Study (GWAS) data, we performed Mendelian randomisation (MR) to assess causality between 41 cytokines and EM. Positive Single Nucleotide Polymorphisms (SNPs) were annotated via Multi-marker Analysis of GenoMic Annotation (MAGMA) and intersected with EM-associated genes from Weighted Gene Co-expression Network Analysis (WGCNA). Shared genes underwent single-gene Gene Set Enrichment Analysis (GSEA). The association of shared genes with endometriosis was validated by the quantitative Real-Time Polymerase Chain Reaction (qRT-PCR) method. Two-sample MR identified TNF-Related Apoptosis-Inducing Ligand (TRAIL) as causally linked to EM. Inverse variance weighting (IVW) revealed that elevated TRAIL levels reduced EM risk (β = -0.061, p = 2.267e-6). WGCNA identified DSG 2 (a TRAIL-related gene related to EM). Quantitative analysis based on clinical samples confirmed the low expression of DSG 2 in patients with endometriosis. GSEA indicated DSG 2 participation in many signalling pathways. MR analysis revealed that elevated TRAIL levels significantly reduce the risk of EM. MAGMA and WGCNA analyses identified DSG 2 as a key gene associated with TRAIL. Gene expression analysis combined with GSEA suggested that decreased DSG 2 expression may influence the development of EM through various pathways. These results offer new potential diagnostic markers and therapeutic targets for EM.

How does surgery influence female sexuality in patients with endometriosis compared to those with other benign gynecological conditions?

BACKGROUND

Endometriosis is a chronic, estrogen-dependent, benign condition, affecting 10-15% of women of reproductive age. It is associated with a prevalence of sexual dysfunction that is nearly twice as high as that seen in women with other benign gynecological conditions. Our study aimed to assess the effect of surgical intervention on sexual function, as measured by the FSFI (Female Sexual Function Index) score, in women with endometriosis compared to those with other benign gynecological conditions, both before and after surgery.

METHODS

A comparative analysis was conducted at the Medical University of Vienna from 2015 to 2020. The study included patients suspected of having endometriosis, fibroids, adnexal cysts, and/or infertility. Based on findings during surgery, patients were categorized into two groups: those with endometriosis (n = 64) and control patients (n = 38). All participants completed the FSFI questionnaire before surgery and again 8 to 18 weeks after the operation.

RESULTS

No significant differences were observed in the preoperative FSFI scores between the endometriosis patients and the control group. Similarly, no significant differences were found between the two groups in postoperative scores. However, in women diagnosed with endometriosis, surgical removal of endometriotic lesions significantly increased their full-scale FSFI score, and resulted in a significant improvement in the areas "desire" and "satisfaction". Improvements were noted in all other areas as well, though they were not statistically significant.

CONCLUSIONS

Our research indicates that the surgical removal of endometriotic lesions can lead to an improvement in sexual function, as measured by the FSFI, within 8 to 18 weeks post-surgery. This improvement was not observed in the control group, which underwent surgery for other benign gynecological issues.

The Effect of Circulating Inflammatory Proteins on Endometriosis: A Mendelian Randomization Study

Background

Endometriosis is a complex gynecological condition in which endometrial fragments are implanted outside the uterus, causing pain and infertility. Although immune mediators play a vital role in endometriosis, their exact etiology remains elusive. Using Mendelian randomization (MR), this study aimed to assess the causal relationship between inflammatory proteins and endometriosis.

Methods

Genetic variants associated with inflammatory proteins were filtered from a genome-wide protein quantitative trait locus study under stringent thresholds. These variants were used as instrumental variables (IVs) to evaluate the causal effects of these inflammatory proteins on endometriosis. A two-sample MR analysis was performed with endometriosis from the UK Biobank as the outcome, and a sensitivity analysis was performed to mitigate potential confounding factors. Analyses were replicated in an independent endometriosis cohort from the FinnGen, followed by a meta-analysis of MR results from both cohorts. Finally, we assessed the causality between inflammatory proteins and the endometriosis subtypes.

Results

Independent MR analysis revealed that the genetically higher levels of CXCL5 were linked to a lower chance of having endometriosis. The causal link remained significant in the meta-analysis. Furthermore, the causality of CXCL5 expression has been identified in ovarian and pelvic peritoneal endometriosis.

Conclusion

Our MR analysis indicated that CXCL5 was associated with a decreased risk of endometriosis, suggesting that CXCL5 might have a protective effect against endometriosis. This enhances our understanding of the involvement of chemokines in endometriosis pathology and provides insights for future studies to explore the detailed mechanisms underlying CXCL5 in endometriosis.

Recent Advances in Endometriosis Pathophysiology and Pharmacological Treatment

Endometriosis, affecting an estimated 10% of women of reproductive age [...].

Immune Checkpoints in Endometriosis-A New Insight in the Pathogenesis

Endometriosis (EMS) is an oestrogen-dependent, chronic disease affecting women of a reproductive age. One of the important factors involved in the development of this disease is the complex disorders associated with the functioning of the immune system. Recent evidence has shown that EMS development is associated with changes in systemic and local immunity, including functional disturbances of effector and antigen-presenting cells. One of the reasons for immune imbalance can be the improper expression of immune checkpoints (ICPs). ICPs and their ligands are responsible for maintaining self-tolerance and the modulation of the initiation, duration, and magnitude of the immune response of effector cells in normal tissues to avoid tissue damage. Considering the complex nature of co-stimulatory or co-inhibitory ICPs and the signalling between effector cells and APCs, we hypothesise that changes in cells' activity caused by ICPs may lead to serious immune system disturbances in patients with endometriosis. Moreover, both upregulation and downregulation in the expression of ICPs may be implicated in this process, including the reduced activity of effector cells against endometrial implants and disturbances in the antigen-presenting process. In this narrative review, we discuss, for the first time, key findings from the emerging literature, describing the associations between ICPs and their possible implication in the pathogenesis of endometriosis.

Identification of central genes for endometriosis through integration of single-cell RNA sequencing and bulk RNA sequencing analysis

This study aimed to identify the key genes involved in the development of endometriosis and construct an accurate predictive model to provide new directions for the diagnosis and treatment of endometriosis. Using bioinformatics analysis, we employed the single-cell cell communication method to identify the key cell subtypes. By combining chip data and integrating differential analysis, WGCNA analysis, and the least absolute shrinkage and selection operator (LASSO) model, key genes were identified for immune infiltration and functional enrichment analyses. Cell communication analysis identified tissue stem cells as the key subtype. Differential analysis revealed 1879 differentially expressed genes, whereas WGCNA identified 357 module genes. The LASSO model further selects 4 key genes: Adipocyte Enhancer Binding Protein 1(AEBP1), MBNL1, GREM1, and DES. All 4 key genes showed significant correlations with immune cell content. Moreover, these genes were significantly expressed in single cells. The predictive model demonstrated good diagnostic performance. Through scRNA-seq, WGCNA, and LASSO methodologies, DES, GREM1, MBNL1, and AEBP1 emerged as crucial core genes linked to tissue stem cell markers in endometriosis. These genes have promising applications as diagnostic markers and therapeutic targets for endometriosis.