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Microbes & Immunity A disruptive solution for endometriosis

cardiovascular-endothelial glycocalyx coupling, reduce paper, directly or indirectly. Peter S. Staats is the founder of
inflammation, correct coagulopathy, and maintain tissue the ElectroCore company which sells nVNS device called
O supply” all by itself. 115 gammaCore. Separately, other authors declared that they
2
Last but not least, non-invasive VNS, which is easier and have no known competing financial interests or personal
more sustainable than pharmacological (hormonal or relationships that could have influenced the work reported
116
anti-inflammatory ) options or microbiota transplants, in this paper.
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could even prevent the spontaneous occurrence of cancers Author contributions
linked to endometriosis. Indeed, ovarian cancer is the
most important associated cancer, wherein a direct clonal Conceptualization: Claire-Marie Rangon, Peter S. Staats
relationship between endometriosis and cancer has been Writing – original draft: Claire-Marie Rangon
made. A recent large cohort from Utah (including Writing – review & editing: Peter S. Staats, Shaoyuan Li,
119
78,893 women with endometriosis and those without Alba Boluda-Nicola, Jérôme Bouaziz
endometriosis, in a 1:5 ratio) confirms a marked increase
of ovarian cancer risk (multiplied by 4.2 in average, Ethics approval and consent to participate
but up to 7.48, depending on the histological type of Not applicable.
cancer) in women with ovarian and/or deep infiltrating
endometriosis. Moreover, although research has not Consent for publication
120
found a direct link between endometriosis and breast Not applicable.
cancer, so far, women with hormone-sensitive breast
cancers should not be subjected to hormonal regulation Availability of data
of their endometriosis. On the contrary, an increased
vagal tone, notably induced through non-invasive VNS, Not applicable.
is correlated with a better prognosis in breast cancer as References
120
well as in cancer in general. 108,109 Non-invasive VNS thus
appears as a promising candidate for primary as well as 1. Horne AW, Missmer SA. Pathophysiology, diagnosis, and
secondary prevention of endometriosis. Thus, non-invasive management of endometriosis. BMJ. 2022;379:e070750.
VNS could be a potential lifelong innovative therapeutic doi: 10.1136/bmj-2022-070750
solution for endometriosis, since the early phase of 2. Dabi Y, Suisse S, Marie Y, et al. New class of RNA biomarker
symptom manifestation, as it improves compliance. 121 for endometriosis diagnosis: The potential of salivary piRNA

5. Conclusion expression. Eur J Obstet Gynecol Reprod Biol. 2023;291:88-95.
doi: 10.1016/j.ejogrb.2023.10.015
Merging both top-down and bottom-up mechanisms,
vagus nerve-mediated regulation of immunity emerges as 3. Bendifallah S, Suisse S, Puchar A, et al. Salivary
an etiological therapeutic intervention in endometriosis, MicroRNA signature for diagnosis of endometriosis. JCM.
offering patients a convenient therapeutic strategy to 2022;11(3):612.
improve their quality of life as well as their prognosis. It is doi: 10.3390/jcm11030612
necessary to conduct clinical trials assessing the efficiency 4. Bendifallah S, Dabi Y, Suisse S, et al. Validation of a Salivary
and tolerability of the very early use of this disruptive miRNA Signature of Endometriosis - Interim Data. NEJM
approach to tackle, particularly, pain, inflammation, and Evid. 2023;2(7):EVIDoa2200282.
even the onset of endometriosis.
doi: 10.1056/EVIDoa2200282
Acknowledgments 5. Canis M, Abbott J, Abrao M, et al. A call for new theories
on the pathogenesis and pathophysiology of endometriosis.
None. J Minim Invasive Gynecol. 2024;31(5):371-377.
Funding doi: 10.1016/j.jmig.2024.02.004
None. 6. Bulun SE, Yilmaz BD, Sison C, et al. Endometriosis. Endocr
Rev. 2019;40(4):1048-1079.
Conflict of interest doi: 10.1210/er.2018-00242
Claire-Marie Rangon and Peter S. Staats are the Guest 7. Rahmioglu N, Mortlock S, Ghiasi M, et al. The genetic basis
Editors of this special issue but were not in any way involved of endometriosis and comorbidity with other pain and
in the editorial and peer-review process conducted for this inflammatory conditions. Nat Genet. 2023;55(3):423-436.

Volume 1 Issue 2 (2024) 50 doi: 10.36922/mi.4389