Cecil, A.; Vouk, K.; Novak Pusic, M.; Vogler, A.; Wenzl, R.; Prehn, C.; Adamski, J.; Lanisnik Rizner, T.

Endometriosis, a common inflammatory gynecological disorder affecting up to 10% of women worldwide, is characterized by the presence of endometrium-like tissue outside the uterus. Current diagnostic methods, such as ultrasound and MRI, effectively detect ovarian and deep endometriosis but fail to detect more common peritoneal type. Diagnosing peritoneal endometriosis currently necessitates invasive laparoscopy and histological confirmation. Despite numerous efforts, no new reliable biomarkers have successfully transitioned into routine clinical use. This study aimed to investigate the use of targeted metabolomics to discover metabolite ratios capable of identifying endometriosis in plasma samples. We analyzed a discovery population of 235 patients and a validation population of 278 patients. All cases and controls in both populations were diagnosed by laparoscopy. Control subjects included individuals presenting with symptoms such as pain, dysmenorrhea, infertility, or other benign conditions, but who had no laparoscopic evidence of endometriosis. Using generalized linear models (GLMs) and machine learning, the study identified specific metabolite ratios as potential biomarkers that can distinguish different types of endometriosis and enable mass spectrometry-based diagnostics for peritoneal endometriosis. The best-validated GLM, derived from the concentration ratios of amino acids, acylcarnitines, sphingomyelins, and phosphatidylcholines, consisted of Thr/SM(OH) C22:2 + PC aa C40:5/SFA_PC + lysoPC a C16:0/SM(OH) C16:1. This model yielded an AUC of 0.82 (95% CI 0.619-0.891, with 76% sensitivity and 81% specificity) for peritoneal endometriosis. This innovative approach offers a robust diagnostic model, addressing an unmet medical need by facilitating earlier detection of peritoneal endometriosis and improving overall clinical management.