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Peripheral Blood Leukocyte Telomere Length and Endometriosis

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Abstract

Endometriosis is a common gynecologic disease defined by the presence of endometrial-like tissue outside the uterine cavity. While its etiology is largely unknown, accumulating evidence suggests that inflammation plays a major role. Our objective was to investigate the association between peripheral blood leukocyte telomere length (LTL) and endometriosis using data from two large population-based studies, the New England Case-Control Study (NEC; n = 877) and the National Health and Nutrition Examination Survey (NHANES; n = 2268). NEC control participants were identified through a combination of random digit dialing, drivers’ license lists, and town resident lists. In NHANES, selection algorithms were used to identify a nationally representative sample. Blood samples and demographic, reproductive, and health-related information were available from both data sources. Endometriosis was defined as self-reported of physician-diagnosed endometriosis. LTL was measured using quantitative polymerase chain reaction. Multivariable logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI) for the association between LTL and endometriosis. Shorter LTL was associated with greater odds of history of endometriosis. In NEC, women with the shortest LTL tertile compared with the longest had a 2.5-fold greater odds of endometriosis (ORT3/T1 = 2.56, 95% CI = 1.16–5.63; p value, test for linear trend = 0.02). The association was stronger among women who usually experienced moderate or severe menstrual pain (OR T3/T1 = 3.50, 95% CI = 1.12–10.97). In NHANES, the data suggested a similar but attenuated association (ORT3/T1 = 1.29, 95% CI = 0.85–1.96). The observed associations in NEC suggest that shorter LTL may be associated with greater odds of endometriosis. A better understanding of how LTL influences endometriosis risk could elucidate novel disease pathophysiology.

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Data Availability

The NHANES datasets are available online [https://www.cdc.gov/nchs/nhanes/index.htm]. The NEC data that support the findings of this study are available upon request and review by study leadership. The data are not publicly available due to them containing information that could compromise research participants’ privacy and consent.

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Acknowledgments

The authors would like to thank the participants of the New England Case-Control Study and the National Health and Nutrition Examination Survey for their valuable contribution.

Funding

This work was supported by the Ovarian Cancer Research Fund Liz Tilberis Award. NS was supported by a 2017 BCE/Marriott Family Foundation Trainee Award. SAM and KLT were supported by NICHD grant R01 HD094842. The sponsor had no role in the study design, conduct of the study or data analysis, writing of the report, or decision to submit the article for publication.

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Author notes

  1. Naoko Sasamoto and Jennifer Yland contributed equally to this work.

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Obstetrics and Gynecology Epidemiology Center, Brigham and Women’s Hospital and Harvard Medical School, 221 Longwood Avenue, Boston, MA, 02115, USA

    Naoko Sasamoto, Allison F. Vitonis, Daniel W. Cramer & Kathryn L. Terry

  2. Department of Epidemiology, Boston University, Boston, MA, USA

    Jennifer Yland

  3. Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA

    Jennifer Yland, Daniel W. Cramer, Immaculata De Vivo, Stacey A. Missmer & Kathryn L. Terry

  4. Department of Epidemiology and Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, NH, USA

    Linda J. Titus

  5. Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Immaculata De Vivo

  6. Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, Grand Rapids, MI, USA

    Stacey A. Missmer

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  1. Naoko Sasamoto
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Contributions

NS was responsible for formulation of the study hypotheses and study design, statistical analyses, result interpretation, manuscript writing, revision, and finalization. JY was responsible for study design, statistical analyses, manuscript revision, and finalization. AFV was responsible for data collection, development, and implementation of NEC; study analysis methods; statistical analyses; results interpretation; and manuscript revision and finalization. DWC was responsible for data collection, development, and implementation of NEC, and manuscript revision and finalization. LJT was responsible for data collection, development, and implementation of NEC, and manuscript revision and finalization. IDV was responsible for data generation in NEC data and manuscript finalization. SAM was responsible for analysis methods, results interpretation, and manuscript revision and finalization. KLT was responsible for study design and analysis methods, results interpretation, manuscript revision and finalization, and was also responsible for the overall conceptualization of study.

Corresponding author

Correspondence to Naoko Sasamoto.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Ethics Approval

For the New England Case-Control Study, the Human Subjects Review Committees at Brigham and Women’s Hospital and Dartmouth Medical School approved this study, and each participant provided informed consent. For National Health and Nutrition Examination Survey, the NCHS Research Ethics Review Board approved the study.

Code Availability

All statistical analyses were conducted using SAS; programs are available from the corresponding author upon request.

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Sasamoto, N., Yland, J., Vitonis, A.F. et al. Peripheral Blood Leukocyte Telomere Length and Endometriosis. Reprod. Sci. 27, 1951–1959 (2020). https://doi.org/10.1007/s43032-020-00214-6

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  • DOI: https://doi.org/10.1007/s43032-020-00214-6

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