A promising future for endometriosis diagnosis and therapy: extracellular vesicles - a systematic review

Abstract

Endometriosis is a chronic, inflammatory gynaecological disease that can have severe negative impacts on quality of life and fertility, placing burden on patients and the healthcare system. Due to the heterogeneous nature of endometriosis, and the lack of correlation between symptom and surgical disease severity, diagnosis and treatment remain a significant clinical challenge. Extracellular vesicles (EVs) are biologically active particles containing molecular cargo involved in intercellular communication, that can be exploited for diagnostic and therapeutic purposes.We systematically reviewed studies exploring EVs and their role in endometriosis, specifically addressing diagnostic and therapeutic potential and current understanding of pathophysiology. Five databases (Pubmed, Embase, Medline, Web of Science, Google Scholar) were searched for keywords ‘endometriosis’ and either ‘extracellular vesicles’ or ‘exosomes’.There were 28 studies included in the review. Endometrium derived EVs contribute to the development of endometriosis. EVs derived from endometriosis lesions contribute to angiogenesis, immunomodulation and fibrosis. Such EVs can be detected in blood, with early data demonstrating utility in diagnosis and recurrence detection. EV isolation techniques varied between studies and only eight of twenty-eight studies fully characterised EVs according to current recommended standards. Reporting/type of endometriosis was limited across studies. Varied patient population, type of sample and isolation techniques created bias and difficulty in comparing studies.EVs hold promise for improving care for symptomatic patients who have never had surgery, as well as those with recurrent symptoms after previous surgery. We encourage further EV research in endometriosis with the inclusion of rigorous reporting of both the patient population and technical methodology used, with the ultimate goal of achieving clinical utility for diagnosis, prognosis and eventually treatment.

A importância do diagnóstico precoce da endometriose: revisão de literatura

“…Além disso, o diagnóstico precoce da endometriose desempenha um papel fundamental na preservação da fertilidade. A condição está frequentemente associada a dificuldades para engravidar, e o tratamento precoce pode oferecer opções que visam minimizar o impacto da endometriose na função reprodutiva da mulher 1,5 .…”

“…A endometriose é uma condição ginecológica complexa e desafiadora que afeta milhões de mulheres em todo o mundo. Caracterizada pelo crescimento anormal de tecido semelhante ao endométrio fora do útero, essa condição pode causar uma ampla gama de sintomas, desde dor pélvica intensa até complicações reprodutivas, incluindo infertilidade 1,2 .…”

“…A complexidade da endometriose reside não apenas em seus impactos financeiros, mas também em diversas formas como se manifesta, tornando o diagnóstico precoce um fator determinante para o manejo eficaz da doença 1,3 .…”

“…Ao abordar a importância do diagnóstico precoce, destacamos a relevância de estratégias preventivas e terapêuticas oportunas para melhorar a qualidade de vida das pacientes e mitigar os desafios associados à endometriose 1,4 .…”

Unraveling the Multifaceted Roles of Extracellular Vesicles: Insights into Biology, Pharmacology, and Pharmaceutical Applications for Drug Delivery

“…In contrast to the role of EVs in normal gynecological processes, dysfunctional EV signaling has been associated with gynecological pathology and diseases occurring during pregnancy. These include endometriosis [ 170 ], polycystic ovary syndrome (PCOS) [ 171 ], pre-eclampsia [ 172 ], and gestational diabetes [ 173 ]. For example, elevated EV-associated RNA (DENNDIA gene) in a woman’s urine indicates polycystic ovary syndrome (PCOS) [ 174 ].…”