title: Oxidative cell injury as a predictor of endometriosis progression.
abstract: BACKGROUND
  There is increasing evidence that oxidative stress is one of the key factors for progression of endometriosis. In this prospective controlled trial, we measured 6 different biomarkers of oxidative stress targeting protein, lipid, and DNA to quantify the severity and progression of endometriosis and establish a diagnostic marker for the disease.
  
  
  METHODS
  A total of 62 consecutive patients were identified and enrolled in this study. After exclusion criteria, 44 patients were allocated to 3 groups: stage I/II (n = 14), stage III/IV (n = 16), and a control group (n = 14). The levels of 8-hydroxy-2-deoxyguanosine (8-OHdG), 8-oxoguanine DNA glycosylase (OGG1), protein carbonyl (PC), lipid peroxidation (LPO), reactive oxygen species (ROS), and total antioxidant capacity (TAC) were accessed in peritoneal fluid and tissue.
  
  
  RESULTS
  Significantly higher levels of 8-OHdG and PC were seen in patients with endometriosis, in addition OGG1 expression was found to be significantly lower in patients with endometriosis (P < .001, P = .001, P = .033, respectively); ROS, TAC, and LPO were similar in stages I/II, stages III/IV, and control group. A predictive model was built using multivariable analyses and receiver-operating characteristics curves. The ability to predict and distinguish between patients without endometriosis, stage I/II endometriosis, and stage III/IV was very high. This model was highly discriminatory and had a concordance index of 0.87.
  
  
  CONCLUSIONS
  In this cohort, higher DNA damage and lower DNA repair activity was related to endometriosis progression. Our results indicate that oxidative stress as a biomarker of cell injury can be used as a reliable quantitative test of endometriosis severity.
authors.affiliation: 1Center for Reproductive Medicine, Obstetrics and Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
authors.forename: Luiz Fernando Pina
authors.initials: LF
authors.lastname: Carvalho
authors.forename: Mauricio Simões
authors.initials: MS
authors.lastname: Abrão
authors.forename: Charles
authors.initials: C
authors.lastname: Biscotti
authors.forename: Rakesh
authors.initials: R
authors.lastname: Sharma
authors.forename: Benjamin
authors.initials: B
authors.lastname: Nutter
authors.forename: Tommaso
authors.initials: T
authors.lastname: Falcone
mesh_terms: D000080242:8-Hydroxy-2'-Deoxyguanosine; D000328:Adult; D001202:Ascitic Fluid / Q000737:chemistry; D015415:Biomarkers / Q000032:analysis; D001706:Biopsy; D016022:Case-Control Studies; D004249:DNA Damage; D045647:DNA Glycosylases / Q000032:analysis; D004260:DNA Repair; D003849:Deoxyguanosine / Q000031:analogs & derivatives / Q000032:analysis; D018450:Disease Progression; D004715:Endometriosis / Q000235:genetics / Q000378:metabolism* / Q000473:pathology; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D015227:Lipid Peroxidation; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D018384:Oxidative Stress; D011237:Predictive Value of Tests; D050050:Protein Carbonylation; D012372:ROC Curve; D017382:Reactive Oxygen Species / Q000032:analysis; D015203:Reproducibility of Results; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D017382:Reactive Oxygen Species; D000080242:8-Hydroxy-2'-Deoxyguanosine; D045647:DNA Glycosylases; C479058:oxoguanine glycosylase 1, human; D003849:Deoxyguanosine
keywords: DNA damage: 8-hydroxy-2-deoxyguanosine; cell toxicity; endometriosis; endometriosis progression; oxidative stress