Abstract
This systematic review analyses the contribution of metabolomics to the identification of diagnostic and prognostic biomarkers for uterine diseases. These diseases are diagnosed invasively, which entails delayed treatment and a worse clinical outcome. New options for diagnosis and prognosis are needed. PubMed, OVID, and Scopus were searched for research papers on metabolomics in physiological fluids and tissues from patients with uterine diseases. The search identified 484 records. Based on inclusion and exclusion criteria, 44 studies were included into the review. Relevant data were extracted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) checklist and quality was assessed using the QUADOMICS tool. The selected metabolomics studies analysed plasma, serum, urine, peritoneal, endometrial, and cervico-vaginal fluid, ectopic/eutopic endometrium, and cervical tissue. In endometriosis, diagnostic models discriminated patients from healthy and infertile controls. In cervical cancer, diagnostic algorithms discriminated patients from controls, patients with good/bad prognosis, and with/without response to chemotherapy. In endometrial cancer, several models stratified patients from controls and recurrent from non-recurrent patients. Metabolomics is valuable for constructing diagnostic models. However, the majority of studies were in the discovery phase and require additional research to select reliable biomarkers for validation and translation into clinical practice. This review identifies bottlenecks that currently prevent the translation of these findings into clinical practice.
Highlights
We aim to address the following questions: Has metabolomics contributed to diagnosis or prognosis of uterine diseases to date? Has metabolomics contributed to deciphering the pathophysiology of uterine diseases to date?
After screening of titles and abstracts according to the inclusion and exclusion criteria (Table 2), we excluded 149 duplicate papers and 292 papers that did not meet the criteria, such as studies in animal models, cell lines, nonuterine cancers, nonuterine benign pathologies, and follicular fluid, and studies focusing on transcriptomics, as well as review manuscripts, and studies dealing with MRI
This literature review revealed that over the last decade, metabolomics has contributed to the identification of biomarker candidates for diagnosis of endometriosis and CC, and for prognosis of CC and Endometrial cancer (EC)
Summary
Metabolomics is rapidly gaining importance in medicine [1]. It has great potential for the development of diagnostic and prognostic approaches, to be applied to monitor disease progression, and to determine the effects of therapeutic agents. Metabolomic profiling can contribute to a detailed understanding of pathological molecular mechanisms, which might allow identification of new drug targets [2]. In this manner, metabolomics can tackle the unmet need for better diagnosis and personalized treatment of uterine diseases. There have been a number of metabolomics studies dealing with uterine diseases, with 50 published in 2018, 45 in 2019, and 16 to July 2020, based on the PubMed search (Table 1)
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