Gene Expression Profiling and Pathway Analysis of the Effect of Dienogest on Ovarian Endometriosis: A Comparative Study

Abstract

Purpose: Endometriosis affects about 10% of reproductive-age women and can be managed through medical treatments, surgical intervention, or both. Approximately 40%-50% of patients experience recurrence within 5 years after surgery. Therefore, medical treatments, especially progestins, play a major role in the management of endometriosis. Dienogest has been used to treat endometriosis; however, its effects on endometriosis remain unclear. This study aimed to evaluate the molecular effects of dienogest on endometriosis.

Materials and methods: The enrolled patients were aged ≥20 years, premenopausal, and had pathologically confirmed endometriosis. The study participants consisted of four women who had received dienogest treatment before surgery and four women who had not received any medical treatment before surgery. This study compared the RNA profiles of the dienogest-treated and untreated groups before surgery.

Results: We identified 406 differentially expressed genes by comparing the dienogest-treated and untreated groups and conducted enrichment analysis with an adjusted p-value of <0.05. We identified pathways such as regulation of immune effector processes, leukocyte activation involved in the immune response, cell activation involved in the immune response, and leukocyte cell-cell adhesion.

Conclusion: Comparison of the dienogest-treated and untreated groups before endometriotic ovarian cyst surgery revealed pathways related to immune system function, inflammatory response, cell signaling and adhesion, and metabolic regulation. These findings suggest that dienogest may play a role in controlling inflammation and immune regulation, potentially alleviating endometriosis-related symptoms and delaying recurrence. Although further studies are required for validation, our preliminary findings suggest that dienogest may contribute to delaying the progression from endometriosis to carcinoma.