Catching Endometriosis Early

Three biomarkers helped create a new model of diagnosis that could ascertain the presence of the disease in a timely and efficient manner.

Key Points

Highlights:

• The authors used ultra-high-performance liquid chromatography alongside electrospray ionization high-resolution mass spectrometry (UHPLC-ESI-HRMS) in order to evaluate differences in the metabolomic profile of the eutopic endometrium in women without endometriosis and the women with the disease at minimal-mild stages.
• The end goal is to determine potential biomarkers that can help diagnose minimal-mild endometriosis using a semi-invasive technique.

Importance:

• The authors emphasize the need for this project by drawing readers attention to the non-optimal sensitivity and specificity of the current diagnostic tools used to detect endometriosis at the early stages.

What’s done here?

• Participants:
  • 29 women with endometriosis; 37 women with infertility
  • All women underwent laparoscopy alongside hysteroscopy.
• Sample collection performed during the surgery, by a pipelle biopsy, from all participants.
• The endometrial tissue samples were then prepared for metabolomics. UHPLC-ESI-HRMS was used to quantify the metabolites.
• The data was subject to statistical analysis. A step-wise logistic regression analysis was combined with backward elimination to yield the best biomarkers combination.

Key results:

• Researchers found 12 metabolites that could be endometriosis biomarkers.
• Participants with endometriosis had higher concentrations of the following compounds on their eutopic endometrium metabolomic profile:
  • Hypoxanthine /  L-arginine / L-tyrosine / Leucine / Lysine / Inosine
  • Omega-3 arachidonic acid / Guanosine / Xanthosine / Lysophosphatidylethanolamine / Asparagine
• The participants with endometriosis had lower concentrations of uric acid.
• The best combination of biomarkers was factored into a model for early diagnosis of endometriosis that looks at uric acid, hypoxanthine, and lysophosphatidylethanolamine. The sensitivity of this model is 66.7% and the specificity is 90.0%

Limitations of the study:

• The findings of the study may not be applicable to individuals from other parts of the world due to minor differences in the molecular makeup. The cohort is small.
• The low sensitivity should be improved, and the relation is direct, not surrogate; should be confirmed.

Lay Summary

Li et al., a group primarily from Sun Yat-sen University in the People’s Republic of China, recently published an article titled “Endometrium metabolomic profiling reveals potential biomarkers for diagnosis of endometriosis at minimal-mild stages” in Reproductive Biology and Endocrinology. The paper addresses the lack of an optimal diagnostic tool for individuals with minimal-mild stage endometriosis. The researchers used ultra-high-performance liquid chromatography alongside electrospray ionization high-resolution mass spectrometry (UHPLC-ESI-HRMS) in order to discover differences in the eutopic endometrium metabolomic profile in women with and without endometriosis. The ultimate goal was to create a model comprised of various biomarkers that would allow for the timely diagnosis of endometriosis at its early stages.

The study had 29 participants who suffered from stage I-II endometriosis and 37 participants that suffered from infertility. During surgery, the researchers collected eutopic endometrium samples from all the participants using a pipelle endometrial biopsy. The aforementioned UHPLC-ESI-HRMS method was used to quantify the different metabolites. The data underwent statistical analysis. Namely, the researchers used a step-wise logistic regression analysis and backward elimination to create a model that includes the best biomarkers for the diagnosis of endometriosis.

There were 12 metabolites whose concentrations varied between women with early stage endometriosis and women without the disease. Women with early-stage endometriosis had higher concentrations of the following: hypoxanthine, L-arginine, L-tyrosine, leucine, lysine, inosine, omega-3 arachidonic acid, guanosine, xanthosine, lysophosphatidylethanolamine, and asparagine. The same participants had lower concentrations of uric acid.

The model that was constructed at the end for the timely diagnosis of endometriosis relied on the concentrations of uric acid, hypoxanthine, and lysophosphatidylethanolamine. The aforementioned model had a sensitivity of 66.7% and a specificity of 90.0%.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/29712562