Diagnostic value of serum activin A and follistatin levels in women with peritoneal, ovarian and deep infiltrating endometriosis
Abstract
BACKGROUND: Activin A is a growth factor, produced by the endometrium, whose actions are modulated by the binding protein follistatin. Both proteins are detectable in the peripheral serum and their concentrations may be increased in women with endometriosis. The present study was designed to evaluate whether serum levels of activin A and follistatin are altered, and therefore have a potential diagnostic value, in women with peritoneal, ovarian and deep infiltrating endometriosis. METHODS: We performed a multicenter controlled study evaluating simultaneously serum activin A and follistatin concentrations in women with and without endometriosis. Women with endometriosis (n = 139) were subdivided into three groups: peritoneal endometriosis (n = 28); ovarian endometrioma (n = 61) and deep infiltrating endometriosis (n = 50). The control group (n = 75) consisted of healthy women with regular menstrual cycles. Blood samples were collected from a peripheral vein and assayed for activin A and follistatin using commercially available enzyme immunoassay kits. RESULTS: The ovarian endometrioma group had serum activin A levels significantly higher than healthy controls (0.22 ± 0.01 ng/ml versus 0.17 ± 0.01 ng/ml, P < 0.01). None of the endometriosis groups had serum follistatin levels which were significantly altered compared with healthy controls; however, levels found in the endometrioma group (2.34 ± 0.32 ng/ml) were higher than that in the deep endometriosis group (1.50 ± 0.17 ng/ml, P < 0.05). The area under the receiver operating characteristic curve of activin A was 0.700 (95% confidence interval: 0.605-0.794), while that of follistatin was 0.620 (95% confidence interval: 0.510-0.730) for the diagnosis of ovarian endometrioma. The combination of both markers into a duo marker index did not improve significantly their diagnostic accuracy. CONCLUSIONS: The present study demonstrated that serum activin A and follistatin are not significantly altered in peritoneal or deep infiltrating endometriosis and have limited diagnostic accuracy in the diagnosis of ovarian endometrioma.
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Women with endometriosis demonstrate higher levels of activin than unaffected controls.
“Women with endometriosis demonstrate higher levels of activin than unaffected controls (Cahill & Hull, 2000; Reis et al., 2012; Rombauts et al., 2006) and giving activin to mice promotes endometriotic lesion growth (Kasai et al., 2019).”
From Endometriosis and polycystic ovary syndrome are diametric disorders (2021) · cites this paper as Reis et al., 2012
A follow-up study could not reproduce the follistatin results.
“However, a follow-up study could not reproduce these results [44].”
From Update on biomarkers for the detection of endometriosis (2015) · cites this paper as [44]
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- Authors
- Reis, F. M., Luisi, S., Abrao, M. S., Rocha, A. L. L., Vigano, P., Rezende, C. P., Florio, P., & Petraglia, F.
- Affiliations
- University of Siena (IT)
- Corresponding author
- Petraglia, F.
- Venue
- Human Reproduction
- Publisher
- Oxford University Press (OUP)
- Published
- 2012-03-12
- Volume
- 27
- Issue
- 5
- Pages
- 1445-1450
- ISSN
- 0268-1161 (ISSN-L)
- 1460-2350
- OpenAlex
- W2170208581
- Cited by
- 43
- References
- 40
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 3 · 2023: 1 · 2022: 3 · 2021: 7 · 2020: 2 · 2019: 1 · 2017: 1 · 2016: 6 · 2015: 5 · 2014: 2 · 2013: 3 · 2012: 2
- FWCI
- 4.47
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Human Reproduction (publishedVersion)
- PubMed (publishedVersion)
- Scientific Electronic Library Online (São Paulo Research Foundation, Latin American and Caribbean Center on Health Sciences Information, Conselho Nacional de Desenvolvimento Científico e Tecnológico) (publishedVersion)
- CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
- Florence Research (University of Florence) (submittedVersion)
- Use Siena air (University of Siena) (submittedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ectopic Pregnancy Diagnosis and Management
- Life Sciences › Agricultural and Biological Sciences › Ecology, Evolution, Behavior and Systematics › Plant and fungal interactions
- Keywords
- endometriosis, activin A, follistatin, serum biomarkers, peritoneal endometriosis, endometrioma, deep infiltrating endometriosis, diagnostic accuracy, TGF-beta superfamily signaling, ovarian reserve markers
- MeSH terms
- Adult, Endometriosis, Female, Humans, Ovarian Diseases, Peritoneal Diseases, Biomarkers, Case-Control Studies, Activins, Follistatin
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