Abstract
The diagnosis of endometriosis is typically delayed by years for the unexclusive symptom and the traumatic diagnostic method. Several studies have demonstrated that gut microbiota and cervical mucus potentially can be used as auxiliary diagnostic biomarkers. However, none of the previous studies has compared the robustness of endometriosis classifiers based on microbiota of different body sites or demonstrated the correlation among microbiota of gut, cervical mucus, and peritoneal fluid of endometriosis, searching for alternative diagnostic approaches. Herein, we enrolled 41 women (control, n = 20; endometriosis, n = 21) and collected 122 well-matched samples, derived from feces, cervical mucus, and peritoneal fluid, to explore the nature of microbiome of endometriosis patients. Our results indicated that microbial composition is remarkably distinguished between three body sites, with 19 overlapped taxa. Moreover, endometriosis patients harbor distinct microbial communities versus control group especially in feces and peritoneal fluid, with increased abundance of pathogens in peritoneal fluid and depletion of protective microbes in feces. Particularly, genera of Ruminococcus and Pseudomonas were identified as potential biomarkers in gut and peritoneal fluid, respectively. Furthermore, novel endometriosis classifiers were constructed based on taxa selected by a robust machine learning method. These results demonstrated that gut microbiota exceeds cervical microbiota in diagnosing endometriosis. Collectively, this study reveals important insights into the microbial profiling in different body sites of endometriosis, which warrant future exploration into the role of microbiota in endometriosis and highlighted values on gut microbiota in early diagnosis of endometriosis.
Highlights
Endometriosis (EM) is a chronic inflammatory gynecological disease, with a high prevalence (~10%) of reproductive-age women, and affects approximately 176 million women worldwide (Giudice and Kao, 2004; Hickey et al, 2014)
By profiling the peritoneal fluid microbiomes of women with endometriosis at the reproductive age, the current study provides a new clue that microbes in the peritoneal cavity may contribute to establish a pathogenic microenvironment
Performance of auxiliary diagnosis methods, including but not limited to transvaginal ultrasound (TVS), transabdominal ultrasound (TUS), and magnetic resonance imaging (MRI), varies between studies depending on multiple factors, such as radiologists’ experience and the fundamental structures of different facilities (Guerriero et al, 2013; Wildenberg et al, 2016; Guerriero et al, 2018)
Summary
Endometriosis (EM) is a chronic inflammatory gynecological disease, with a high prevalence (~10%) of reproductive-age women, and affects approximately 176 million women worldwide (Giudice and Kao, 2004; Hickey et al, 2014). 80% women at reproductive age experience retrograde menstruation, but the prevalence of EM is around 10%, giving us a hint that the microenvironment of peritoneal cavity may be different between EM patients and women without EM. The upper genital tract and peritoneal cavity have been largely considered to be sterile areas This concept has been challenged by a considerable number of studies investigating microbial composition across the human body (Chen et al, 2017; Ata et al, 2019). This study comprehensively characterizes the microbiome of the gut, cervix, and peritoneal cavity in the control group and EM patients and elucidates the potential of microbial markers as non-invasive diagnostic tools for identifying EM patients from the control group. The bioinformatic analysis of the gut microbiome has provided stirring glimpses into the putative role of the gut microbiota in directing personalized medical therapy and patient management
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