AT WCE 2017

VANCOUVER (FRONTLINE MEDICAL NEWS) – Investigators at McMaster University in Hamilton, Ontario, are zeroing in on a biomarker blood test panel to diagnose endometriosis without surgery.

At the World Congress on Endometriosis, they described a decision tree incorporating blood levels of brain-derived neurotrophic factor (BDNF), glycodelin, and zinc-alpha2-glycoprotein (ZAG), quantified by enzyme-linked immunosorbent assay. ZAG levels above 91.58 ng/mL – the first cut in the decision tree, glycodelin above 39.19 ng/mL – the second cut, and BDNF above 953.9 pg/mL identified endometriosis with a sensitivity of 89.2% and a specificity of 70.0%. The combination outperformed any biomarker on its own.

BDNF is a protein involved in neurogenesis, angiogenesis, and apoptosis resistance, all hallmark pathogenic features of endometriosis. Glycodelin and ZAG are associated with secretory endometrium.

The three markers were the strongest performers among almost 15 initial candidates that have been associated with the disease, including Interleukin 6, vascular endothelial growth factor, and cancer antigen 125.

The findings come from a comparison of blood levels in 65 women undergoing endometriosis surgery with the blood levels in 14 women undergoing surgery for benign gynecological problems, and in 16 healthy controls with no history of pelvic pain.

The need is great for a noninvasive test to diagnose endometriosis. Currently, diagnosis is made during surgery and can be delayed for several years. Like investigators at other institutions, the research team at McMaster is hoping to develop an easy, accurate way to catch and treat the disease early before complications set in.

Early diagnosis has “resisted our best efforts for years, but we are slowly moving closer to the end zone,” said senior investigator Warren Foster, PhD , a professor of obstetrics and gynecology at McMaster.

Other teams have reported favorable results for microRNAs, circulating endometrial stem cells, biomarker combinations, and other approaches. “It seems to me that there is a lot of progress being made. One of the big issues that we still have to solve is reproducibility, but there’s so much coming forward,” Dr. Foster said. “It’s an exciting time to be looking for novel diagnostic markers for endometriosis.”

The McMaster team next plans to test its panel prospectively in women with suspected early stage disease.

The work was funded by the Canadian Institutes of Health Research. Dr. Foster is in talks with industry to license the algorithm.