Endometriosis Research

Endo Research OBGYN

Endometriosis Research

We are committed to changing lives through research, advancing the world’s understanding of endometriosis for earlier detection, easier diagnosis, better treatments, and improved outcomes.

How We Study Endometriosis 

To improve the understanding and treatment of endometriosis, we conduct:

  • Basic scientific research
  • Clinical research
  • Translational research
  • Interdisciplinary research
  • Collaborative studies with national and international institutions and organizations around the world

The Latest from Our Labs

Learn more about our current areas of focus in endometriosis research, the latest findings, and promising new treatments being explored. 

The Role of Gut Microbiome in Endometriosis

To provide new insight into the factors that contribute to the development of endometriosis, Baylor College of Medicine researchers in the Kommagani Lab, led by Ramakrishna Kommagani, Ph.D., are investigating the role of the gut microbiome, a community of microorganisms living inside the body, in endometriosis.

Their findings, as published in the journal Cell Death Discovery, suggest that certain gut microbiome communities and/or their metabolites – products produced by the microbes – can contribute to endometriosis progression, and that modifying the composition of these communities could help control the condition in human patients.

The findings also suggest that studying microbiome metabolites in human stool samples could be used as a diagnostic tool. 

Resource
From the Labs: Altered gut microbiome and its products promote endometriosis in animal model

Exploring Potential New Endometriosis Treatments 

The Sang Jun Han Lab is focused on defining a new molecular mechanism to explain how endometriosis initiates and progresses, enabling the development of new treatments that suppress the progression of the disease without the adverse effects of current hormonal therapies. 

In a recent study published in the Journal of Biomedical Science, the team found that oleuropein, a natural component found in olive leaves, suppressed the growth of endometriosis lesions in mouse models and improved the pregnancy rate in mice with endometriosis. 

Future studies will explore the value of oleuropein as a non-hormonal therapy to treat endometriosis.

Resource
From the Labs: Exploring a potential new treatment for endometriosis

Gene Identified That Increases the Risk of Endometriosis

Research conducted by Baylor College of Medicine (BCM) in collaboration with the University of Oxford, the University of Wisconsin-Madison, and Bayer AG used genetic analyses of two species with spontaneous endometriosis – humans and rhesus monkeys – to identify a specific gene, NPSR1, that increases the risk of the disease. 

As published in Science Translational Medicine, the insights revealed in the genetic analysis point to a potential new nonhormonal drug target to reduce the inflammation and abdominal pain caused by endometriosis.

The study, which involved Dr. Jeffrey Rogers’ BCM Human Genome Sequencing Center lab, is one of the first examples of DNA sequencing in nonhuman primates to validate results in human studies, and the first to significantly impact our understanding of the genetics of common, complex metabolic diseases. 

Resource
From the Labs: NPSR1 gene link to endometriosis reveals a potential drug target

Studying the Endometrium to Improve Women’s Reproductive Health

Led by Diana Monsivais, Ph.D., the Monsivais Lab in the department of Pathology and Immunology at Baylor is focused on better understanding the cell signals that prepare the endometrium, the lining of the uterus, for pregnancy. New knowledge on how these signals control epithelial cell remodeling, stromal cell differentiation, and regeneration offers new potential to address diseases that affect the endometrium, including endometriosis, endometrial cancer, menstrual disorders and infertility. 

During her Ph.D. studies in Dr. Serdar Bulun’s lab, Dr. Monsivais discovered the critical roles of GTPases and kinases, components of signaling pathways, in the development of endometriosis. Today, her team uses genetically engineered mice and innovative 3D human translational models to study and identify when the signaling pathways of endometrial regeneration go awry. 

Promising New Endometriosis Drug Interventions 

Dr. Diana Monsivais and Drs. Stephen Palmer and Martin Matzuk from Baylor’s Center for Drug Discovery lead a team of drug discovery investigators poised to develop therapeutic kinase inhibitors that can cause regression of endometriosis lesions and eliminate the pain associated with this disease.  

The team is working with Baylor’s minimally invasive gynecologic surgeon Dr. Xiaoming Guan to obtain donated lesions from consenting endometriosis patients to study the effectiveness of these new drug interventions.

In patients with endometriosis, the body responds to endometrial-like cells growing outside the uterus by generating an inflammatory response to destroy the lesions. The team’s goal is to pause this immune response with a kinase inhibitor, enabling the lesions to undergo cell death while preserving normal uterine cells. The investigators are also working on demonstrating the ability of these kinase inhibitors to interrupt the transmission of pain signals to the brain, in animal models.

Endometriosis Research from Dr. Xiaoming Guan and Dr. Joseph Nassif

Baylor endometriosis specialists Dr. Xiaoming Guan, division chief of Minimally Invasive Gynecologic Surgery, and Dr. Joseph Nassif, associate professor of Obstetrics and Gynecology and minimally invasive gynecologic surgeon, provide outstanding care for today's endometriosis patients and conduct extensive research that will improve the care of this disease for generations to come. From new insight into the pathogenesis of endometriosis to new minimally invasive techniques for surgically managing deeply infiltrated endometriosis (DIE), they continue adding to the body of knowledge on this complex condition. 

Lovell DY, Sendukas E, Yang Q, Guan X. Surgical Enhancement With the Placement of Temporary Bilateral Ureteral Stents With Indocyanine Green Injection for All Stages of Endometriosis in vNOTES: Retrospective Cross-Sectional Study. J Minim Invasive Gynecol. 2025 Feb;32(2):166-170. doi: 10.1016/j.jmig.2024.09.365. Epub 2024 Oct 1. PMID: 39362404.

Guan X, Yang Q, Lovell DY. Assessing Feasibility and Outcomes of Robotic Single Port Transvaginal NOTES (RSP-vNOTES) Hysterectomy: A Case Series. J Minim Invasive Gynecol. 2024 Dec;31(12):1041-1049. doi: 10.1016/j.jmig.2024.08.018. Epub 2024 Sep 1. PMID: 39222841.

Park Y, Guan X, Han SJ. N-Myc and STAT Interactor is an Endometriosis Suppressor. Int J Mol Sci. 2024 Jul 26;25(15):8145. doi: 10.3390/ijms25158145. PMID: 39125716; PMCID: PMC11312104.

Guan X, Lovell DY, Zurawin R. The Evolution of Transvaginal Robot-Assisted Surgery in Gynecology. Surg Technol Int. 2024 Jul 15;44:181-184. doi: 10.52198/24.STI.44.GY1786. PMID: 38776238.

Delgadillo Chabolla LE, Alpuing Radilla LA, Koythong T, Sunkara S, Mendez Y, Wang Q, Guan X. Exploring the feasibility of indocyanine green fluorescence for intraoperative ureteral visualisation in robotic transvaginal natural orifice transluminal endoscopy surgery during endometriosis resection. Int J Med Robot. 2024 Jun;20(3):e2636. doi: 10.1002/rcs.2636. PMID: 38757434.

Xu G, Lovell DY, Guan X. Robot-Assisted Vaginal Natural Orifice Transluminal Endoscopic Surgery (RvNOTES) With Total Hysterectomy for Management of Stage IV Endometriosis With/Without Complete Cul-de-Sac Obliteration: 23-Case Pilot Feasibility Study. J Minim Invasive Gynecol. 2024 Jun;31(6):496-503. doi: 10.1016/j.jmig.2024.03.006. Epub 2024 Mar 16. PMID: 38493829.

Madasu C, Liao Z, Parks SE, Sharma KL, Bohren KM, Ye Q, Li F, Palaniappan M, Tan Z, Yuan F, Creighton CJ, Tang S, Masand RP, Guan X, Young DW, Monsivais D, Matzuk MM. Identification of potent pan-ephrin receptor kinase inhibitors using DNA-encoded chemistry technology. Proc Natl Acad Sci U S A. 2024 May 7;121(19):e2322934121. doi: 10.1073/pnas.2322934121. Epub 2024 May 3. PMID: 38701119; PMCID: PMC11087803.

Dunn TN, Cope DI, Tang S, Sirupangi T, Parks SE, Liao Z, Yuan F, Creighton CJ, Masand RP, Alpuing Radilla L, Guan X, Detti L, Monsivais D, Matzuk MM. Inhibition of CSF1R and KIT with pexidartinib reduces inflammatory signaling and
cell viability in endometriosis. Endocrinology. 2024 Jan 16:bqae003. doi:10.1210/endocr/bqae003. Epub ahead of print. PMID: 38227801.

Monsivais D, Liao Z, Tang S, Jiang P, Geng T, Cope D, Dunn T, Guner J, Radilla LA, Guan X. Impaired bone morphogenetic protein (BMP) signaling pathways disrupt decidualization in endometriosis. Res Sq [Preprint]. 2023 Nov 9:rs.3.rs-3471243. doi: 10.21203/rs.3.rs-3471243/v1. PMID: 37986901; PMCID: PMC10659538.

Liao Z, Tang S, Jiang P, Geng T, Cope DI, Dunn TN, Guner J, Radilla LA, Guan X, Monsivais D. Impaired bone morphogenetic protein signaling pathways disrupt decidualization in endometriosis. bioRxiv [Preprint]. 2023 Sep
22:2023.09.21.558268. doi: 10.1101/2023.09.21.558268. PMID: 37790548; PMCID: PMC10542516.

Guan X, Guan Z, Sunkara S, Thigpen B. Indocyanine Green-Assisted Retrograde Ureterolysis in Robotic Transvaginal NOTES for the Management of Stage IV Endometriosis with Obliterated Cul-de-sac. J Minim Invasive Gynecol. 2023
Apr;30(4):266-267. doi: 10.1016/j.jmig.2023.02.005. Epub 2023 Feb 9. PMID: 36764648.

Park Y, Cho YJ, Sung N, Park MJ, Guan X, Gibbons WE, O'Malley BW, Han SJ.Oleuropein suppresses endometriosis progression and improves the fertility of mice with endometriosis. J Biomed Sci. 2022 Nov 22;29(1):100. doi:
10.1186/s12929-022-00883-2. PMID: 36419064; PMCID: PMC9682776.

Sunkara S, Guan X. Robotic vaginal natural orifice transluminal endoscopic myomectomy. Fertil Steril. 2022 Aug;118(2):414-416. doi: 10.1016/j.fertnstert.2022.05.009. Epub 2022 Jun 9. PMID: 35691722.

Guan Z, Soni SD, Zhou J, Sunkara S, Guan X. Cystoscopic-guided Robotic Resection of Bladder Trigone Endometriosis Nodule with Ureteral Preservation. J Minim Invasive Gynecol. 2022 Aug;29(8):930-931. doi: 10.1016/j.jmig.2022.05.012. Epub 2022 May 23. PMID: 35618233.

Kristina Duan, Xiaoming Guan. Multidisciplinary management of ovarian remnant syndrome involving ureteral stent with ICG dyne for ureteral preservation. Intelligent Surgery. 2022, ISSN 2666-6766, https://doi.org/10.1016/j.isurg.2022.05.001.

Thigpen B, Koythong T, Guan X. Robotic-assisted Laparoscopic Ureterolysis for Deep Infiltrating Endometriosis using Indocyanine Green Under Near-Infrared Fluorescence. J Minim Invasive Gynecol. 2022 May;29(5):586-587. doi:
10.1016/j.jmig.2022.01.018. Epub 2022 Feb 10. PMID: 35151876.

Guan X, Welch JR, Wu G. Robotic Transvaginal Natural Orifice Transluminal Endoscopic Surgery for Resection of Parametrial and Bowel Deeply Infiltrated Endometriosis. J Minim Invasive Gynecol. 2022 Mar;29(3):341-342. doi:
10.1016/j.jmig.2021.11.020. Epub 2021 Dec 3. PMID: 34871771.

Fan X, Duan K, Zhang C, Guan X. Feasibility of two robotic single-site surgery techniques for adolescent endometriosis: Focal versus butterfly. Int J Med Robot. 2022 Feb;18(1):e2339. doi: 10.1002/rcs.2339. Epub 2021 Oct 25. PMID: 34661960.

Zhang Y, Delgado S, Liu J, Guan Z, Guan X. Robot-assisted Transvaginal Natural Orifice Transluminal Endoscopic Surgery for Management of Endometriosis: A Pilot Study of 33 Cases. J Minim Invasive Gynecol. 2021 Dec;28(12):2060-2066. doi: 10.1016/j.jmig.2021.06.004. Epub 2021 Jun 15. PMID: 34144208.

Delgado SI, Koythong T, Turrentine MA, Sangi-Haghpeykar H, Guan X. Postoperative opioid use for patients with chronic pelvic pain undergoing robotic surgery for resection of endometriosis. J Robot Surg. 2022
Apr;16(2):421-427. doi: 10.1007/s11701-021-01259-8. Epub 2021 Jun 2. PMID: 34075544.

Huang Y, Duan K, Koythong T, Patil NM, Fan D, Liu J, Guan Z, Guan X. Application of robotic single-site surgery with optional additional port for endometriosis: a single institution's experience. J Robot Surg. 2022
Feb;16(1):127-135. doi: 10.1007/s11701-021-01217-4. Epub 2021 Mar 2. PMID: 33651315.

Rezai S, Giovane RA, Mann T, Patil NM, Bardawil E, Henderson CE, Guan X. Laparoscopic Vessel Endometriosis Resection Surgery: A Case Report and Review of Literature. Case Rep Obstet Gynecol. 2019 Dec 12;2019:1375208. doi: 10.1155/2019/1375208. PMID: 31915556; PMCID: PMC6930385.

Shadi Rezai MD, Neil D. Patel BS, Alexander C. Hughes BSN, Ninad M. Patil MD, Elise Bardawil MD, Cassandra E. Henderson MD, Xiaoming Guan MD PhD. Da Vinci SILS-Appendectomy For Appendiceal Endometriosis Secondary To Stage IV Endometriosis, A Case Report And Review Of Literature, , Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecology Surgery, Houston, Texas, Obstetrics & Gynecology International Journal (OGIJ), ISSN: 2377-4304, Volume 9 Issue 4, August 1 2018, Pages 276-279, Article ID: 00347, Web: http://medcraveonline.com/OGIJ/OGIJ-09-00347.pdf, DOI: https://doi.org/10.15406/ogij.2018.09.00347

Xia W, Zhang D, Ouyang J, Liang Y, Zhang H, Huang Z, Liang G, Zhu Q, Guan X, Zhang J. Effects of pelvic endometriosis and adenomyosis on ciliary beat frequency and muscular contractions in the human fallopian tube. Reprod Biol Endocrinol. 2018 May 12;16(1):48. doi: 10.1186/s12958-018-0361-y. PMID: 29753325; PMCID: PMC5948789.

Guan X, Bardawil E, Liu J, Kho R. Transvaginal Natural Orifice Transluminal Endoscopic Surgery as a Rescue for Total Vaginal Hysterectomy. J Minim Invasive Gynecol. 2018 Nov-Dec;25(7):1135-1136. doi: 10.1016/j.jmig.2018.01.028. Epub 2018 Feb 7. PMID: 29427780.

Zhang D, Xia W, Tong T, Li C, Shi W, Yan MX, Xue RH, Guan XM, Zhang J. Correlation between Cyr61 expression and clinicopathologic parameters in adenomyosis. J Reprod Immunol. 2016 Nov;118:42-49. doi: 10.1016/j.jri.2016.08.004. Epub 2016 Aug 17. PMID: 27644084.

Wang SY, Yin L, Guan XM, Xiao BB, Zhang Y, Delgado A. Single Port Transumbilical Laparoscopic Surgery versus Conventional Laparoscopic Surgery for Benign Adnexal Masses: A Retrospective Study of Feasibility and Safety. Chin Med J (Engl). 2016 Jun 5;129(11):1305-10. doi: 10.4103/0366-6999.182829. PMID: 27231167; PMCID: PMC4894040.

Guan X, Nguyen MT, Walsh TM, Kelly B. Robotic Single-Site Endometriosis Resection Using Firefly Technology. J Minim Invasive Gynecol. 2016 Jan;23(1):10-1. doi: 10.1016/j.jmig.2015.08.001. Epub 2015 Aug 7. PMID:
26260298. 

Burla L, Kalaitzopoulos DR, Samartzis N, Khazali S, Bokor A, Renner SP, Hudelist G, Constantin AS, Schäfer SD, Nassif J, Naem A, Keckstein J, Krentel H; EEL MDT meeting Consensus Group. Recommendations for the implementation and conduct of multidisciplinary team meetings for those providing endometriosis and adenomyosis care - a Delphi consensus of the European Endometriosis League (EEL). Facts Views Vis Obgyn. 2024 Sep;16(3):337-350. doi: 10.52054/FVVO.16.3.038. PMID: 39357865; PMCID: PMC11569442.

Assaf L, Eid AA, Nassif J. Role of AMPK/mTOR, mitochondria, and ROS in the pathogenesis of endometriosis. Life Sci. 2022 Oct 1;306:120805. doi: 10.1016/j.lfs.2022.120805. Epub 2022 Jul 15. PMID: 35850246. 

El Taha L, Abu Musa A, Khalifeh D, Khalil A, Abbasi S, Nassif J. Efficacy of dienogest vs combined oral contraceptive on pain associated with endometriosis: Randomized clinical trial. Eur J Obstet Gynecol Reprod Biol. 2021 Dec;267:205-212. doi: 10.1016/j.ejogrb.2021.10.029. Epub 2021 Oct 30. PMID: 34826668.    

Nassif J., Khalil Ali M, Aswad N, Abu Musa A, Rameh G Endometriosis and Epigenetics: What do we know? Women Health Open Journal 2018; 4(1): 1-7.2018, vol.4, no.1, pp-1-7. 

Nassif J, Abbasi SA, Nassar A, Abu-Musa A, Eid AA The Role Of Nadph-Derived Reactive Oxygen Species Production in the Pathogenesis of Endometriosis: A Novel Mechanistic Approach. Journal of Biological Regulators and Homeostatic Agents. 2016, vol.30, no.1, pp-31-40. 

Seracchioli R, Montanari G, Mabrouk M, Nassif J. Endometriosis: novel models, diagnosis, and treatment. Biomed Res Int. 2014;2014:140413. doi: 10.1155/2014/140413. Epub 2014 Dec 30. PMID: 25610856; PMCID: PMC4293778. 

Nassif J, Mattar S, Abu Musa A, Eid A. Endometriosis and cancer: what do we know? Minerva Ginecol. 2013 Apr;65(2):167-79. PMID: 23598782.

Miranda-Mendoza I, Kovoor E, Nassif J, Ferreira H, Wattiez A. Laparoscopic surgery for severe ureteric endometriosis. Eur J Obstet Gynecol Reprod Biol. 2012 Dec;165(2):275-9. doi: 10.1016/j.ejogrb.2012.07.002. Epub 2012 Jul 22. PMID: 22824570. 

Gabriel B, Nassif J, Trompoukis P, Lima AM, Barata S, Lang-Avérous G, Wattiez. Prevalence and outcome of urinary retention after laparoscopic surgery for severe endometriosis--does histology provide answers? Int Urogynecol J. 2012   Jan;23(1):111- 6. doi: 10.1007/s00192-011-1492-2. Epub 2011 Jul 6. PMID: 21732097. 

Gabriel B, Nassif J, Trompoukis P, Barata S, Wattiez A. Prevalence and management of urinary tract endometriosis: a clinical case series. Urology. 2011. Dec;78(6):1269-74. doi: 10.1016/j.urology.2011.07.1403. Epub 2011 Sep 29.  PMID: 21962747. 

Nassif J, Trompoukis P, Barata S, Furtado A, Gabriel B, Wattiez A. Management of deep endometriosis. Reprod Biomed Online. 2011 Jul;23(1):25-33. doi: 10.1016/j.rbmo.2010.08.012. Epub 2010 Sep 7. PMID: 21474383. 

Kovoor E, Nassif J, Miranda-Mendoza I, Lang-Avérous G, Wattiez A. Long-Term Urinary Retention after Laparoscopic Surgery for Deep Endometriosis. Fertility and Sterility. 2011, vol.95, no.2, pp-803.e9-12.

Kovoor E, Nassif J, Miranda-Mendoza I, Wattiez A. Endometriosis of bladder: outcomes after laparoscopic surgery. J Minim Invasive Gynecol. 2010 Sep- Oct;17(5):600-4. doi: 10.1016/ j.jmig.2010.05.008. Epub 2010 Jul 24. PMID: 20656568. 

Kovoor E, Nassif J, Miranda-Mendoza I, Baulon E, Wattiez A. Hematometra following laparoscopic resection of retrocervical and rectovaginal endometriosis. Fertil Steril. 2010 Apr;93(6):2074.e11-2. doi: 10.1016/j.fertnstert.2009.10.033. Epub 2010 Jan 13. PMID: 20074728. 

Ignacio MM, Joseph N, Hélder F, Mamourou K, Arnaud W. Massive ascites, pleural effusion, and diaphragmatic implants in a patient with endometriosis. Eur J Obstet Gynecol Reprod Biol. 2010 Mar;149(1):117-8. doi: 10.1016/j.ejogrb.2009.10.017. Epub 2009 Nov 18. PMID: 19926198.