Obstetrics and Gynaecology - Research Publications

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    A molecular staging model for accurately dating the endometrial biopsy
    Teh, WT ; Chung, J ; Holdsworth-Carson, SJ ; Donoghue, JF ; Healey, M ; Rees, HC ; Bittinger, S ; Obers, V ; Sloggett, C ; Kendarsari, R ; Fung, JN ; Mortlock, S ; Montgomery, GW ; Girling, JE ; Rogers, PAW (NATURE PORTFOLIO, 2023-10-06)
    Natural variability in menstrual cycle length, coupled with rapid changes in endometrial gene expression, makes it difficult to accurately define and compare different stages of the endometrial cycle. Here we develop and validate a method for precisely determining endometrial cycle stage based on global gene expression. Our 'molecular staging model' reveals significant and remarkably synchronised daily changes in expression for over 3400 endometrial genes throughout the cycle, with the most dramatic changes occurring during the secretory phase. Our study significantly extends existing data on the endometrial transcriptome, and for the first time enables identification of differentially expressed endometrial genes with increasing age and different ethnicities. It also allows reinterpretation of all endometrial RNA-seq and array data that has been published to date. Our molecular staging model will significantly advance understanding of endometrial-related disorders that affect nearly all women at some stage of their lives, such as heavy menstrual bleeding, endometriosis, adenomyosis, and recurrent implantation failure.
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    The genetic basis of endometriosis and comorbidity with other pain and inflammatory conditions
    Rahmioglu, N ; Mortlock, S ; Ghiasi, M ; Moller, PL ; Stefansdottir, L ; Galarneau, G ; Turman, C ; Danning, R ; Law, MH ; Sapkota, Y ; Christofidou, P ; Skarp, S ; Giri, A ; Banasik, K ; Krassowski, M ; Lepamets, M ; Marciniak, B ; Noukas, M ; Perro, D ; Sliz, E ; Sobalska-Kwapis, M ; Thorleifsson, G ; Topbas-Selcuki, NF ; Vitonis, A ; Westergaard, D ; Arnadottir, R ; Burgdorf, KS ; Campbell, A ; Cheuk, CSK ; Clementi, C ; Cook, J ; De Vivo, I ; DiVasta, A ; Dorien, O ; Donoghue, JF ; Edwards, T ; Fontanillas, P ; Fung, JN ; Geirsson, RT ; Girling, JE ; Harkki, P ; Harris, HR ; Healey, M ; Heikinheimo, O ; Holdsworth-Carson, S ; Hostettler, IC ; Houlden, H ; Houshdaran, S ; Irwin, JC ; Jarvelin, M-R ; Kamatani, Y ; Kennedy, SH ; Kepka, E ; Kettunen, J ; Kubo, M ; Kulig, B ; Kurra, V ; Laivuori, H ; Laufer, MR ; Lindgren, CM ; MacGregor, S ; Mangino, M ; Martin, NG ; Matalliotaki, C ; Matalliotakis, M ; Murray, AD ; Ndungu, A ; Nezhat, C ; Olsen, CM ; Opoku-Anane, J ; Padmanabhan, S ; Paranjpe, M ; Peters, M ; Polak, G ; Porteous, DJ ; Rabban, J ; Rexrode, KM ; Romanowicz, H ; Saare, M ; Saavalainen, L ; Schork, AJ ; Sen, S ; Shafrir, AL ; Siewierska-Gorska, A ; Slomka, M ; Smith, BH ; Smolarz, B ; Szaflik, T ; Szyllo, K ; Takahashi, A ; Terry, KL ; Tomassetti, C ; Treloar, SA ; Vanhie, A ; Vincent, K ; Vo, KC ; Werring, DJ ; Zeggini, E ; Zervou, M ; Stefansson, K ; Nyegaard, M ; Uimari, O ; Yurttas-Beim, P ; Tung, JY ; Adachi, S ; Buring, JE ; Ridker, PM ; D'Hooghe, T ; Goulielmos, GN ; Hapangama, DK ; Hayward, C ; Horne, AW ; Low, S-K ; Martikainen, H ; Chasman, D ; Rogers, PAW ; Saunders, PT ; Sirota, M ; Spector, T ; Strapagiel, D ; Whiteman, DC ; Giudice, LC ; Velez-Edwards, DR ; Kraft, P ; Salumets, A ; Nyholt, DR ; Magi, R ; Becker, CM ; Steinthorsdottir, V ; Missmer, SA ; Montgomery, GW ; Morris, AP ; Zondervan, KT (NATURE PORTFOLIO, 2023-03)
    Endometriosis is a common condition associated with debilitating pelvic pain and infertility. A genome-wide association study meta-analysis, including 60,674 cases and 701,926 controls of European and East Asian descent, identified 42 genome-wide significant loci comprising 49 distinct association signals. Effect sizes were largest for stage 3/4 disease, driven by ovarian endometriosis. Identified signals explained up to 5.01% of disease variance and regulated expression or methylation of genes in endometrium and blood, many of which were associated with pain perception/maintenance (SRP14/BMF, GDAP1, MLLT10, BSN and NGF). We observed significant genetic correlations between endometriosis and 11 pain conditions, including migraine, back and multisite chronic pain (MCP), as well as inflammatory conditions, including asthma and osteoarthritis. Multitrait genetic analyses identified substantial sharing of variants associated with endometriosis and MCP/migraine. Targeted investigations of genetically regulated mechanisms shared between endometriosis and other pain conditions are needed to aid the development of new treatments and facilitate early symptomatic intervention.
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    Gene expression of the endocannabinoid system in endometrium through menstrual cycle
    Tanaka, K ; Amoako, AA ; Mortlock, S ; Rogers, PAW ; Holdsworth-Carson, SJ ; Donoghue, JF ; Teh, WT ; Montgomery, GW ; McKinnon, B (NATURE PORTFOLIO, 2022-06-07)
    Endocannabinoids mediate cellular functions and their activity is controlled by a complex system of enzymes, membrane receptors and transport molecules. Endocannabinoids are present in endometrium, a cyclical regenerative tissue requiring tightly regulated cellular mechanisms for maturation. The objective of this study was to investigate the gene expression of key elements involved in the endocannabinoid system across the menstrual cycle. RNA was isolated from endometrial tissue and genome-wide gene expression datasets were generated using RNA-sequencing. An a priori set of 70 genes associated with endocannabinoid system were selected from published literature. Gene expression across the menstrual cycle was analyzed using a moderated t test, corrected for multiple testing with Bonferroni's method. A total of 40 of the 70 genes were present in > 90% of the samples, and significant differential gene expression identified for 29 genes. We identified 4 distinct regulation patterns for synthesizing enzymes, as well as a distinct regulation pattern for degradations and transporting enzymes. This study charts the expression of endometrial endocannabinoid system genes across the menstrual cycle. Altered expression of genes that control endocannabinoid may allow fine control over endocannabinoid concentrations and their influence on cellular function, maturation and differentiation as the endometrium matures through the menstrual cycle.
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    Tissue specific regulation of transcription in endometrium and association with disease
    Mortlock, S ; Kendarsari, RI ; Fung, JN ; Gibson, G ; Yang, F ; Restuadi, R ; Girling, JE ; Holdsworth-Carson, SJ ; Teh, WT ; Lukowski, SW ; Healey, M ; Qi, T ; Rogers, PAW ; Yang, J ; McKinnon, B ; Montgomery, GW (OXFORD UNIV PRESS, 2020-02)
    STUDY QUESTION: Are genetic effects on endometrial gene expression tissue specific and/or associated with reproductive traits and diseases? SUMMARY ANSWER: Analyses of RNA-sequence data and individual genotype data from the endometrium identified novel and disease associated, genetic mechanisms regulating gene expression in the endometrium and showed evidence that these mechanisms are shared across biologically similar tissues. WHAT IS KNOWN ALREADY: The endometrium is a complex tissue vital for female reproduction and is a hypothesized source of cells initiating endometriosis. Understanding genetic regulation specific to, and shared between, tissue types can aid the identification of genes involved in complex genetic diseases. STUDY DESIGN, SIZE, DURATION: RNA-sequence and genotype data from 206 individuals was analysed and results were compared with large publicly available datasets. PARTICIPANTS/MATERIALS, SETTING, METHODS: RNA-sequencing and genotype data from 206 endometrial samples was used to identify the influence of genetic variants on gene expression, via expression quantitative trait loci (eQTL) analysis and to compare these endometrial eQTLs with those in other tissues. To investigate the association between endometrial gene expression regulation and reproductive traits and diseases, we conducted a tissue enrichment analysis, transcriptome-wide association study (TWAS) and summary data-based Mendelian randomisation (SMR) analyses. Transcriptomic data was used to test differential gene expression between women with and without endometriosis. MAIN RESULTS AND THE ROLE OF CHANCE: A tissue enrichment analysis with endometriosis genome-wide association study summary statistics showed that genes surrounding endometriosis risk loci were significantly enriched in reproductive tissues. A total of 444 sentinel cis-eQTLs (P < 2.57 × 10-9) and 30 trans-eQTLs (P < 4.65 × 10-13) were detected, including 327 novel cis-eQTLs in endometrium. A large proportion (85%) of endometrial eQTLs are present in other tissues. Genetic effects on endometrial gene expression were highly correlated with the genetic effects on reproductive (e.g. uterus, ovary) and digestive tissues (e.g. salivary gland, stomach), supporting a shared genetic regulation of gene expression in biologically similar tissues. The TWAS analysis indicated that gene expression at 39 loci is associated with endometriosis, including five known endometriosis risk loci. SMR analyses identified potential target genes pleiotropically or causally associated with reproductive traits and diseases including endometriosis. However, without taking account of genetic variants, a direct comparison between women with and without endometriosis showed no significant difference in endometrial gene expression. LARGE SCALE DATA: The eQTL dataset generated in this study is available at http://reproductivegenomics.com.au/shiny/endo_eqtl_rna/. Additional datasets supporting the conclusions of this article are included within the article and the supplementary information files, or are available on reasonable request. LIMITATIONS, REASONS FOR CAUTION: Data are derived from fresh tissue samples and expression levels are an average of expression from different cell types within the endometrium. Subtle cell-specifc expression changes may not be detected and differences in cell composition between samples and across the menstrual cycle will contribute to sample variability. Power to detect tissue specific eQTLs and differences between women with and without endometriosis was limited by the sample size in this study. The statistical approaches used in this study identify the likely gene targets for specific genetic risk factors, but not the functional mechanism by which changes in gene expression may influence disease risk. WIDER IMPLICATIONS OF THE FINDINGS: Our results identify novel genetic variants that regulate gene expression in endometrium and the majority of these are shared across tissues. This allows analysis with large publicly available datasets to identify targets for female reproductive traits and diseases. Much larger studies will be required to identify genetic regulation of gene expression that will be specific to endometrium. STUDY FUNDING/COMPETING INTEREST(S): This work was supported by the National Health and Medical Research Council (NHMRC) under project grants GNT1026033, GNT1049472, GNT1046880, GNT1050208, GNT1105321, GNT1083405 and GNT1107258. G.W.M is supported by a NHMRC Fellowship (GNT1078399). J.Y is supported by an ARC Fellowship (FT180100186). There are no competing interests.