Plasma AXIN1 expression exhibit negative correlations with inflammatory biomarkers and is associated with gastrointestinal symptoms in endometriosis

Abstract

The cytoplasmic protein AXIN1 is involved in the Wnt signalling pathway and its expression is increased in patients with endometriosis compared with healthy controls. The aim of the present cross-sectional study was to further assess the levels of AXIN1 and other inflammatory biomarkers in patients with endometriosis. Patients with laparoscopy-verified endometriosis were recruited (n=172) and completed a questionnaire regarding socioeconomic factors, lifestyle habits and medical history. Plasma AXIN1 and high-sensitivity C-reactive protein (hs-CRP) levels were analysed by ELISA. The levels of calprotectin were determined in the faeces, and the haemoglobin concentration and number of erythrocytes, leukocytes and platelets were determined in the blood in a subgroup of 64 patients during clinical routine procedures. F-calprotectin expression was detected in 18 women (28.1%), who had more severe constipation and more frequently experienced incomplete evacuation when defecating, and 5 women (7.8%) exhibited elevated levels. P-AXIN1 levels were higher in patients who received hormonal treatment, and correlated inversely with faecal-calprotectin levels (P=0.003), B-haemoglobin levels (P=0.030) and the numbers of B-erythrocytes (P=0.033) and B-platelets (P=0.017), but were not correlated with hs-CRP levels (P=0.818). Higher levels of AXIN1 were associated with the duration of the gastrointestinal symptoms and with diarrhoea, constipation, vomiting and nausea and the intestinal symptoms' effect on quality of life, and tended to be associated with the duration of endometriosis. Hs-CRP expression was not associated with the clinical characteristics or symptoms of endometriosis, but higher levels were associated with obesity (P=0.002) and hormonal treatment (P=0.011). In conclusion, P-AXIN1 expression was negatively correlated with certain inflammatory biomarkers and was positively associated with gastrointestinal symptoms. P-AXIN1 levels were increased in patients who received hormonal treatment, highlighting the importance of obtaining native samples for future studies regarding its role in the development and presentation of endometriosis. However, hs-CRP and other studied biomarkers seemed to be of no value for the assessment and diagnosis of endometriosis.

Associations Between Endometriosis and Gut Microbiota

“…A previous study has described an association between the protein AXIN1 and endometriosis in humans [ 17 ]. The study showed that plasma levels of AXIN1 were higher in patients with current hormone treatment, positively correlated with both duration and degree of gastrointestinal symptoms, and negatively correlated with levels of fecal calprotectin.…”

“…However, we could not find any correlation between AXIN1 levels and abundance of bacteria, which differed between those with or without gastrointestinal symptoms or hormonal treatment. The correlation between fecal calprotectin and Ruminococcus could possibly reflect more inflammation in the group treated with hormones [ 17 ].…”

“…Levels of plasma AXIN1 and fecal calprotectin were analyzed by ELISA as previously described by Dihm et al [ 17 ].…”

“…Recent studies have shown that the gut microbiota is a major regulator of inflammatory processes outside the gastrointestinal tract [14], factors which may be involved in the pathogenesis of endometriosis [15]. The cytoplasmic protein AXIN1 is involved in the regulation of apoptosis and has been reported to be a potential new biomarker for endometriosis [16], with correlations to clinical data such as gastrointestinal symptoms and hormone treatment [17].…”

Plasma biomarkers for systemic inflammation in COVID‐19 survivors

“…Similarly, AXIN1 acts as a repressor of the Wnt signaling pathway, which is involved in cell proliferation. A negative correlation between AXIN1 and inflammatory markers in patients with endometriosis has been reported [34].…”