Oskotsky, T. T.; Tang, X.; Arthurs, E.; Govil, A.; Abbasi, F.; Bhoja, A.; Bunis, D. J.; Lau, A.; Einhaus, J.; Diop, M.; Irwin, J. C.; Gaudilliere, B.; Stevenson, D. K.; Giudice, L. C.; McAllister, S. L.; Sirota, M.

Introduction and Methods: Endometriosis has limited treatment options, prompting the search for novel therapeutics. We previously used a transcriptomics-based computational drug repositioning pipeline to analyze public bulk transcriptomic data and identified several drug candidates. Fenoprofen, our top in silico candidate, was validated in a rat model. Building on this, we now evaluate two additional candidates, simvastatin (a cholesterol-lowering drug) and primaquine (an antimalarial), based on strong gene expression reversal scores and favorable safety profiles. Using a validated rat model of endometriosis and pain, we conducted behavioral testing, bulk RNA sequencing, and differential expression analysis to assess their therapeutic potential. Results: Of 299 drugs identified computationally, simvastatin and primaquine ranked highly for reversing gene expression signatures associated with endometriosis. In vivo validation using a rat model of endometriosis demonstrated that both drugs significantly reduced vaginal hyperalgesia, a surrogate marker of endometriosis-associated pain. RNA-seq of uteri and lesions confirmed reversal of disease-associated gene expression signatures following treatment. Conclusion: Simvastatin and primaquine attenuated pain behaviors and reversed endometriosis-related gene expression changes in an animal model. These findings highlight their potential as repurposed therapeutics for endometriosis-related pain and support the effectiveness of computational drug repositioning strategies in identifying new treatment strategies.