Oxidative DNA damage may promote the development of endometriosis by activating telomerase and extending telomere length: a meta-analysis

To investigate the associations between oxidative DNA damage biomarkers (levels of 8-hydroxy-2’-deoxyguanosine [8-OHdG], telomere length [TL], human telomerase reverse transcriptase [hTERT], telomerase activity [TA] and polymorphisms of human 8-oxoguanine glycosylase 1 [hOGG1] or X-ray repair cross-complementing group 4 [XRCC4]) and endometriosis (EMT) by a meta-analysis. Five databases were searched until August 2024. Stata version 15.0 was used to estimate pooled odds ratio (OR) or standardized mean difference (SMD) with 95% confidence intervals (CIs). Forty-two studies were included. Overall meta-analysis revealed significantly elevated 8-OHdG (SMD = 1.84; 95%CI = 1.29–2.39), TA (SMD = 3.03; 95%CI = 2.07–4.00) and hTERT (SMD = 2.55; 95%CI = 1.55–3.55) in EMT women compared to controls. Women carrying GG genotype (vs. GC+CC: OR = 1.34; 95%CI = 1.00–1.78) of hOGG1 rs1052133, TT genotype (vs. TG+GG: OR = 2.67; 95%CI = 1.63–4.38) and T allele (vs. G: OR = 3.49; 95%CI = 2.27–5.35) of XRCC4 rs6869366 had a higher risk of developing EMT. Subgroup and trim-and-fill analyses indicated longer TL was a risk factor for EMT. 8-OHdG, TA, hTERT, TL, rs1052133 and rs6869366 represent potential prediction biomarkers and treatment targets for EMT.