Aquaporin-9 and endometriomas: pathophysiological insights from a case-control study

Emine KIRŞAN İLERİ, Kirsan Ileri E, Emine Kirsan Ileri, Anıl Ertürk, Anil Erturk, Yenigul N, Nazlı Yenigul, Nazlı Yenigül, Gulten Ozgen, Burcu Dinçgez, Burcu Dinçgez Çakmak, Nergis Kender Ertürk
Biomarkers : biochemical indicators of exposure, response, and susceptibility to chemicals · 2026 · vol. 31(1) , pp. 60–65 · doi:10.1080/1354750x.2026.2615799 · PMID:41520185 · W7121575263
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Peritoneal fluid aquaporin-9 concentrations were significantly higher in women with endometriomas, correlating with endometrioma presence and size, suggesting a role in the condition's pathophysiology.

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Abstract

INTRODUCTION: Endometriosis is an estrogen-dependent condition characterized by ectopic implantation of endometrial tissue; molecular mechanisms underlying lesion persistence remain incompletely understood. Aquaporins (AQPs), transmembrane water channels involved in migration and proliferation, have been implicated in endometriosis pathophysiology, although data on AQP9 are limited. METHODS: This prospective case-control study evaluated AQP9 concentrations in serum, peritoneal fluid, and cervicovaginal secretions of women with endometriomas compared with healthy surgical controls. Twenty-seven women with unilateral endometrioma and 30 undergoing bilateral tubal ligation were included. AQP9 levels were measured using ELISA, and analyses included correlation, receiver operating characteristic (ROC) curve analysis, and logistic regression adjusted for age, body mass index (BMI), gravida and parity. RESULTS: Peritoneal fluid AQP9 concentrations were significantly higher in women with endometriomas than in controls (275 [58-669] vs. 171.5 [6.6-507] ng/mL, p = 0.023), whereas serum and cervicovaginal AQP9 levels showed no differences. ROC analysis demonstrated high sensitivity (92.6%) but limited specificity (43.3%). Logistic regression confirmed that peritoneal AQP9 > 128 ng/mL was independently associated with endometrioma (OR 4.40, 95%CI 1.66-29.28, p = 0.025). Serum AQP9 was inversely correlated with endometrioma size (p = 0.008). CONCLUSION: Peritoneal AQP9 elevation reflects alterations in the local peritoneal microenvironment, supporting its potential role in the pathophysiology of endometriosis.
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Abstract

Introduction Endometriosis is an estrogen-dependent condition characterized by ectopic implantation of endometrial tissue; molecular mechanisms underlying lesion persistence remain incompletely understood. Aquaporins (AQPs), transmembrane water channels involved in migration and proliferation, have been implicated in endometriosis pathophysiology, although data on AQP9 are limited.

Methods

This prospective case–control study evaluated AQP9 concentrations in serum, peritoneal fluid, and cervicovaginal secretions of women with endometriomas compared with healthy surgical controls. Twenty-seven women with unilateral endometrioma and 30 undergoing bilateral tubal ligation were included. AQP9 levels were measured using ELISA, and analyses included correlation, receiver operating characteristic (ROC) curve analysis, and logistic regression adjusted for age, body mass index (BMI), gravida and parity.

Results

Peritoneal fluid AQP9 concentrations were significantly higher in women with endometriomas than in controls (275 [58–669] vs. 171.5 [6.6–507] ng/mL, p = 0.023), whereas serum and cervicovaginal AQP9 levels showed no differences. ROC analysis demonstrated high sensitivity (92.6%) but limited specificity (43.3%). Logistic regression confirmed that peritoneal AQP9 > 128 ng/mL was independently associated with endometrioma (OR 4.40, 95%CI 1.66–29.28, p = 0.025). Serum AQP9 was inversely correlated with endometrioma size (p = 0.008).

Conclusion

Peritoneal AQP9 elevation reflects alterations in the local peritoneal microenvironment, supporting its potential role in the pathophysiology of endometriosis. CLINICAL SIGNIFICANCE Peritoneal fluid aquaporin-9 (AQP9) levels were significantly elevated in women with endometriomas compared with healthy controls, independently of age and body mass index. This finding suggests that AQP9 may reflect local inflammatory and signaling changes in the peritoneal environment rather than serving as a systemic biomarker. Understanding AQP9’s role in endometriosis may provide insight into the molecular mechanisms underlying lesion persistence and progression, supporting future research into targeted therapeutic or diagnostic approaches aimed at modulating fluid transport, inflammation, and cellular migration in endometriosis. Authors contributions E.K.I.: Data curation, Investigation, Writing- Original draft preparation, Resources A.E.: Formal analysis, Writing- Original draft preparation, supervision N.Y: Investigation, Resources G.O: Investigation, Visualization B.D.: Formal analysis, Visualization N.K.E.: Conceptualization, Methodology, Writing- Reviewing and Editing, Supervision. Disclosure statement No potential conflict of interest was reported by the author(s). Declaration of generative AI and AI-assisted technologies in the writing process During the preparation of this work, the authors used ChatGPT (OpenAI) to assist with language editing. After using this tool, the authors thoroughly reviewed and edited the content as needed and take full responsibility for the final version of the manuscript Data availability statement Data are available from the corresponding author upon reasonable request.

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Condition tags

endometriosisendometrioma

MeSH descriptors

Aquaporins Aquaporins Aquaporins Aquaporins Aquaporins Aquaporins Aquaporins Aquaporins Aquaporins Aquaporins Aquaporins Aquaporins Aquaporins Aquaporins Aquaporins Aquaporins Aquaporins Aquaporins Aquaporins Aquaporins

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (17)

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