Clinical Implications of Extracellular Vesicles in Endometriosis: A Systematic Review.

Abstract

Objectives: Endometriosis (EM) is a chronic gynecological condition characterized by the growth of endometrial-like tissue outside the uterus. Diagnosis has traditionally been challenging due to nonspecific symptoms and reliance on invasive procedures like laparoscopy. Recently, extracellular vesicles (EVs) have been implicated in EM pathogenesis, offering potential diagnostic and therapeutic applications. This study systematically reviews the role of EVs in EM.

Materials and methods: A Preferred Reporting Items for Systematic Reviews and Meta-analyses -guided systematic review was conducted. On March 3, 2024, PubMed, Medline, and Scopus were searched using the keywords "endometriosis" and either "extracellular vesicles," "EV," or "EVs," along with "treatment," "monitoring," or "diagnosis." The review included English-language original papers published between 2019 and 2024 focusing on EVs in EM. Studies on animals and those lacking direct references to EM were excluded from the study.

Results: A total of 12 studies, comprising 657 patients, met the inclusion criteria. The studies examined EV cargo for diagnostic and therapeutic applications, with MicroRNAs (miRNAs) being the most frequently analyzed component. Five studies discussed miRNAs as potential diagnostic markers. EVs were also studied for their role in EM pathogenesis, including cell communication, immunomodulation, and angiogenesis.

Conclusion: EVs show promise as noninvasive biomarkers for early-stage EM detection and management. Their involvement in disease pathogenesis suggests potential therapeutic applications. Identifying specific exosomal markers related to EM remains an active area of research.