The main hypothesis for endometriotic lesion formation is retrograde menstruation (menstrual fluid reflux through the fallopian tubes) but the precise pathogenesis remains unclear. There are no noninvasive biomarkers currently used in clinical care but they are essential to improve the diagnosis delay, currently estimated at 8 years. There is no specific treatment and pharmacological options are contraceptive.

With this project, we propose to use menstrual fluid as a relevant biological fluid for endometriosis.
In Aim 1, single-cell transcriptomics and soluble protein multiplex assays on 64 menstrual fluid samples will be used to identify candidate diagnostic biomarkers that differentiate endometriosis affected women from healthy controls. Validation of these biomarkers will be carried out in menstrual fluid samples from 250 women. In Aim 2, menstrual fluid derived organoids cultured with or without immune cells will be used to assess endometriosis associated functional changes and to test new immunomodulatory treatments. In Aim 3, longitudinal cohorts will be established to identify prognostic candidate biomarkers for response to surgery and in vitro fertilization.
Diagnostic and prognostic biomarkers are essential to assess disease establishment, evolution and to choose the most appropriate treatment.

This project will enhance our understanding of endometriosis pathophysiology as well as allow the study of a new biological fluid, relevant to gynecologic and reproductive disorders.