# Systemic Oxidative Stress Markers in Endometriosis: Elevated Advanced Glycation End Products and Sestrin 2 in Women with Ovarian Endometrioma

## TL;DR

The study finds that women with ovarian endometrioma have higher levels of oxidative stress markers AGEs and SESN2, suggesting these could be useful diagnostic biomarkers.

## Contribution

This is the first study to show elevated systemic AGEs and SESN2 in ovarian endometrioma, identifying SESN2 as a promising biomarker candidate.

## Key findings

- Serum AGEs and SESN2 levels were significantly higher in women with ovarian endometrioma compared to healthy controls.
- SESN2 demonstrated high diagnostic accuracy with 87.39% sensitivity and 86.05% specificity for detecting endometrioma.

## Abstract

Background/Objectives: Endometriosis is a chronic inflammatory disease characterized by ectopic endometrial tissue growth and is strongly associated with oxidative stress; however, systemic biomarkers reflecting this stress response remain limited. Advanced glycation end products (AGEs) promote oxidative and inflammatory signaling, while sestrin 2 (SESN2) is a stress-inducible protein involved in cellular redox homeostasis. This prospective case–control study aimed to evaluate serum AGEs and SESN2 levels in women with ovarian endometrioma and to assess their diagnostic performance. Methods: A total of 80 reproductive-aged women were enrolled, including 37 patients with ultrasonographically confirmed ovarian endometrioma and 43 healthy controls. Serum AGEs and SESN2 concentrations were measured using enzyme-linked immunosorbent assay. Results: Both biomarkers were significantly elevated in patients compared with controls (AGEs: 110.11 ± 33.35 vs. 91.70 ± 41.82 ng/mL, p = 0.007; SESN2: 9.32 ± 2.59 vs. 5.57 ± 1.52 ng/mL, p < 0.001). Receiver operating characteristic analysis demonstrated modest discriminatory ability for AGEs (AUC = 0.656), whereas SESN2 showed high diagnostic accuracy (AUC = 0.893), with 87.39% sensitivity and 86.05% specificity at an optimal cut-off value. Neither AGEs nor SESN2 levels were associated with lesion size, laterality, or pain symptoms. Conclusions: These findings provide the first evidence that circulating AGEs and SESN2 are elevated in ovarian endometrioma, supporting the role of systemic oxidative stress and stress-response pathways in endometriosis. SESN2, in particular, emerges as a promising biomarker candidate for disease presence, warranting further validation in larger and more diverse endometriosis cohorts.