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Genomics 108 (2016) 151–157

Contents lists available at ScienceDirect

Genomics

journal homepage: www.elsevier.com/locate/ygeno

A PubMed-wide study of endometriosis


Ji-Long Liu ⁎, Miao Zhao
College of Veterinary Medicine, South China Agricultural University, Guangzhou 510642, China

a r t i c l e i n f o a b s t r a c t

Article history: Endometriosis affects 5–10% of women in reproductive age, leading to dysmenorrhea, pelvic pain and infertility;
Received 14 June 2016 however, our understanding on the pathogenesis of this disease remains incomplete. In the present study, we
Received in revised form 30 September 2016 performed a systematic analysis of endometriosis-related genes using text mining. Taking text mining results
Accepted 12 October 2016
as input, we subsequently generated a filtered gene set by computing the likelihood of finding more than expect-
Available online 13 October 2016
ed occurrences for every gene across the disease-centered subset of the PubMed database. Characterization of
Keywords:
this filtered gene set by gene ontology, pathway and network analysis provides clues to the multiple mechanisms
Endometriosis hypothesized to be responsible for the establishment of ectopic endometrial tissues, including the migration, im-
Pathogenesis plantation, survival and proliferation of ectopic endometrial cells. Finally, using this gene set as “seed”, we
Text mining scanned human genome to predict novel candidate genes based on gene annotations from multiple databases.
Gene prioritization Our study provides in-depth insights into the pathogenesis of endometriosis.
© 2016 Elsevier Inc. All rights reserved.

1. Introduction large number of genes are identified, our understanding on the patho-
genesis of this disease remains incomplete.
Endometriosis is a common gynecological disorder, defined as the A wealth of information is hidden within the large number of molec-
presence of endometrial tissue outside the uterine cavity, primarily on ular measurements from published experimental results. In the present
the pelvic peritoneum and ovaries. It affects 5–10% of women in repro- study, we performed a text mining analysis of endometriosis-associated
ductive age and clinical manifestations are dysmenorrhea, pelvic pain genes. A filtered gene set was subsequently generated by using
and infertility [1]. The pathogenesis of endometriosis is not fully under- hypergeometric test. Analysis of this filtered gene set provides in-
stood. Several hypotheses have been suggested, such as retrograde depth insights into molecular mechanisms underlying the pathogenesis
menstrual reflux [2], immune system defects [3,4], and ectopic presence of endometriosis.
of endometrial stem cells [5]. Notably, menstrual shedding is likely re-
quired for the development of endometriosis, as endometriosis occurs 2. Methods
spontaneously only in humans and some non-human primates [6].
Studies in twins have confirmed the involvement of genetic factors 2.1. Text mining
in the etiology of endometriosis [7,8]. To elucidate causal genetic vari-
ants underlying endometriosis, many genes with an inferred biological The PubMed database was used as a source of literature for text min-
relevance to endometriosis have been chosen and genetic variants in ing. We conducted a search with the following combinations of query
these genes have been tested for association with the disease [9]. As un- key words: “endometriotic” OR “endometriosis” OR “endometrioma”
biased approaches, several genome-wide association studies (GWAS) OR “endometriomas”. The relevant articles were retrieved in XML for-
have also been performed and a subsequent meta-analysis has revealed mat, which makes information extraction more precise due to presence
6 loci consistently associated with susceptibility to endometriosis [10]. of content enclosed within XML tag pairs. For each article, titles and ab-
Additionally, extensive investigations using conventional methods stract texts were fetched and transformed into the PubTator format [12,
(e.g. Western blot) and high throughput methods (e.g. microarray) 13] using in-house PERL scripts.
have been performed to characterize gene expression differences be- Text mining was performed by using the GNormPlus pipeline [14].
tween the eutopic and ectopic endometrium in order to better under- GNormPlus includes two modules: gene mention recognition and
stand and define the molecular basis of the disease [11]. Despite a gene name normalization, respectively. Gene mentions are detected
by using conditional random fields (CRF) model provided by CRF++ li-
⁎ Corresponding author at: College of Veterinary Medicine, South China Agricultural
brary. Gene mention recognition is integrated with species name recog-
University, No. 483 Wushan Road, Tianhe District, Guangzhou 510642, China. nition by using SR4GN [15]. GenNorm [16], in combination with the
E-mail address: jilongliu@scau.edu.cn (J.-L. Liu). composite mention simplification tool SimConcept [17,18] and the

http://dx.doi.org/10.1016/j.ygeno.2016.10.003
0888-7543/© 2016 Elsevier Inc. All rights reserved.
152 J.-L. Liu, M. Zhao / Genomics 108 (2016) 151–157

Fig. 1. Identification of endometriosis-related genes by text mining. (A) Overview of the text mining pipeline. (B) The cumulative number of publications related to endometriosis from
1980 to 2016. (C) Distribution of the number of publications per gene.

abbreviation resolution tool Ab3P [19], is used for gene name normali- computed text mining results for the whole PubMed database at
zation. Only human genes are considered. By integrating these ad- the PubTator website [13]. We assumed that the total number of
vanced tools, GNormPlus pipeline compares favorably to other state- publications in the PubMed database is N and the number of publica-
of-the-art methods by achieving 87.1% precision and 86.4% recall [14]. tions on this particular gene is m. Then, the hypergeometric test has
Despite the performance was high, errors remained in the out- the following form:
put of GNormPlus. For example, IVF, which is short for in vitro fer-
tilization, was recognized as a gene mention and linked to SCN5A
X
k−1
gene (sodium channel voltage-gated type V alpha subunit) by p ¼ 1− pðijn; m; NÞ
mistake. To ensure accuracy, each entry from GNormPlus output i¼0
was checked manually. We identified 4381 false positive errors
out of a total of 38,490 entries. Thus, the observed precision was
where p(i | n,m,N) is the probability of observing exactly i publica-
4381/38,490 = 88.62%. Finally, all the curated entries were sum-
tions in the endometriosis-centered subset of the PubMed database:
marized and a full gene list associated with endometriosis was
compiled.
n!ðN−nÞ!m!ðN−mÞ!
pðijn; m; NÞ ¼
ðn−iÞ!i!ðn−mÞ!ðN−n−m þ iÞ!N!
2.2. Hypergeometric test

For a certain gene, the frequency of its occurrence in the text Finally, we calculated the significance threshold for multiple testing
mining results is denoted as k. Let the total number of publication using Bonferroni multiple test correction. In this way, the genome-wise
in the text mining results be n. Endometriosis-centered publications error rate is 1 − (1 − αi)n ≈ αin where αi is the individual test rejection
consist only a small part of the PubMed database. In order to esti- level and n is the number of genes under consideration. The algorithm
mate background distribution, we downloaded GNormPlus pre- was implemented in PERL code.

Fig. 2. Filtering of text miming results by hypergeometric test. (A) A flowchart of the filtering process. (B) A Manhattan plot showing filtered results. The genomic location is ticked on the
x-axis and the negative decadic logarithm of the raw p-value is plotted on the y-axis. The dashed horizontal line is the threshold for genome-wide significance at p = 0.01 after Bonferroni
multiple test correction.
J.-L. Liu, M. Zhao / Genomics 108 (2016) 151–157 153

2.3. Gene ontology, pathway and network analysis 2.4. Novel candidate gene prioritization

Gene ontology (GO) analysis was performed by using BiNGO ver- We utilized the Endeavour software [23] for gene prioritization
sion 2.3 with GOslim database [20]. To test for enrichment, a throughout the human genome. Endeavour integrates multiple hetero-
hypergeometric test was conducted followed by customized geneous data sources into a global ranking using order statistics. The
Bonferroni multiple test correction. The adjusted p-value of 0.01 order statistics based p-value, which represents the probability that a
was used as significance threshold to identify enriched GO terms. candidate gene would obtain its rank by chance, is highly dependent
The R package wordcloud was used to generate word cloud for sig- on the number of candidate genes considered. Because there is no rea-
nificantly enriched GO terms. The font sizes in the word cloud sonable threshold for p-values, the top 100 most promising genes
were proportional to − log10 of adjusted p-value for each enriched were selected.
GO terms. The DAVID tool [21] was employed for pathway enrich-
ment analysis. The same significance cutoff as GO analysis was 3. Results
adopted. The STRING database version 10.0 [22] was used to create
gene network. The minimum combined score was set to 0.9. The 3.1. Towards a comprehensive list of endometriosis-related genes
Cytoscape software was applied for visualization and analysis of
the gene network. The threshold of the degree value for hub genes We run a key word search in the PubMed database for articles relat-
was defined as the mean plus two standard deviations. ed to endometriosis and obtained 19,904 articles as a result (from 1980-

Fig. 3. Gene ontology, pathway and network analysis of endometriosis candidate genes. (A) Word cloud of gene ontology (GO) terms enriched among endometriosis candidate genes.
Enrichment test was performed by using BiNGO software configured with GOslim database. The significance cutoff for adjusted p-value was set at 0.01. The font sizes in the word
cloud were proportional to −log10 of adjusted p-value for each enriched GO terms. GO terms were arranged in the biological process (BP) category, the cellular component category
(CC) and the molecular function (MF) category, respectively. (B) Enrichment analysis of pathways for endometriosis candidate genes. The DAVID tool was used and genes are
classified according to the KEGG pathway database. Three pathways were significantly enriched (adjusted p-value b 0.01). (C) The structure of gene network underlying all
endometriosis candidate genes. Nodes represent genes and edges represent gene interactions derived from STRING database. Nodes in red are hub genes with a degree value
exceeding the mean plus two standard deviations.
154 J.-L. Liu, M. Zhao / Genomics 108 (2016) 151–157
J.-L. Liu, M. Zhao / Genomics 108 (2016) 151–157 155

Jan to 2016-Jun). Abstracts of these articles were downloaded and proc- akt murine thymoma viral oncogene homolog 1), MMP9 (matrix
essed through a text mining pipeline (illustrated in Fig. 1A). The number metallopeptidase 9) and IL6 (interleukin 6). These genes are likely
of articles published on endometriosis is growing exponentially in re- more important than other genes due to their key positions in the
cent years (Fig. 1B). From these articles, we extracted endometriosis-as- network.
sociated genes in the title or abstract via text mining. As a result, a total
of 1531 endometriosis-related genes were obtained (Supplementary
Table 1). 3.3. Prioritization of novel candidate genes with Endeavour
We next designed a pipeline to filter the raw text mining results (Fig.
2A). The likelihood that the occurrence for a gene was due to chance It has been shown that genes involved in the same disease share ap-
was calculated and then corrected for multiple testing. The results proximately 80% of annotations in gene ontology and InterPro data-
were used to generate a Manhattan plot (Fig. 2B). We detected 121 bases. Moreover, genes participated in the same biological pathway
genes that reached the statistically significant threshold (adjusted often exhibit a high degree of sequence similarity with other members.
p b 0.01) (Supplementary Table 2). The top 10 genes were: GNRH1 (go- Hence, gene annotations might be indicative of functional importance
nadotropin-releasing hormone 1), MUC16 (mucin 16), FSHB (follicle for a particular disease. In the present study, we performed novel gene
stimulating hormone beta polypeptide), CYP19A1 (cytochrome P450 prioritization by using the Endeavour software to integrate 6 data
family 19A polypeptide 1), VEGFA (vascular endothelial growth factor sources (gene ontology, protein domains from InterPro, KEGG pathway,
A), PGR (progesterone receptor), ESR1 (estrogen receptor 1), AMH microarray expression, gene network from STRING and transcriptional
(anti-Mullerian hormone), PTGS2 (prostaglandin-endoperoxide syn- motifs from TRANSFAC). The 121 genes that were significantly associat-
thase 2) and HOXA10 (homeobox A10). ed with endometriosis were used as the training set. The full genome
was scanned and a global ranking for each gene was generated accord-
ing to order statistics. Finally, the top 100 most promising genes were
3.2. Characterization of endometriosis-related genes selected as novel candidate genes for endometriosis (Fig. 4).
Additionally, we also used the raw text mining results (1531 genes)
The 121 genes that were significantly associated with endometriosis as the training set and performed gene prioritization by using the En-
were tested for enrichment of functional categories, including gene on- deavour software with the same parameters. We used the receiver op-
tology (GO) terms and pathways (Supplementary Table 3). For GO anal- erating characteristic curves (ROC) to compare the performance of
ysis, all candidate genes were functionally categorized based on GOslim Endeavour on the two training sets (Fig. 5). The area under the ROC
annotation terms using the BiNGO tool. Enriched GO terms are classified curve (AUC) statistics served as a useful metric for the performance of
according to biological process (BP), cellular component (CC) and mo- gene prioritization models: whereas an AUC value close to 1 indicates
lecular function (MF) (Fig. 3A). In the BP category, 19 terms were signif- an excellent gene prioritization model, a curve that lies close to the di-
icantly enriched, including signal transduction (p = 7.76e − 12), cell agonal (AUC = 0.5) has no information content. The AUC values for
communication (p = 7.76e − 12), multicellular organismal develop- the gene prioritization model trained on raw text mining results and
ment (p = 7.76e − 12), regulation of biological process (p = the model trained on filtered results were 0.7322 and 0.8344, respec-
8.00e−11), response to external stimulus (p = 2.97e−08), anatomical tively. This analysis provides evidence that our filtered data are superior
structure morphogenesis (p = 5.55e − 08), cell-cell signaling (p = to raw text mining data.
6.26e − 07), lipid metabolic process (p = 1.44e − 06), behavior (p =
4.40e − 06), reproduction (p = 7.11e − 06), oxygen binding (p =
1.53e − 05), response to stress (p = 8.52e − 05), cell proliferation 4. Discussion
(p = 5.12e−04), cell differentiation (p = 1.01e−03), cell death (p =
1.16e − 03), death (p = 1.16e − 03), transcription regulator activity Over the past years, the number of articles published on endometri-
(p = 2.50e−03), response to endogenous stimulus (p = 4.25e−03), osis is growing fast. Numerous genes and pathways have been found to
and response to biotic stimulus (p = 6.96e−03). The enriched CC cat- play a role in this disease. On the other hand, a detailed understanding
egories were extracellular space (p = 2.98e−14), extracellular region of the molecular mechanisms underlying endometriosis is still far
(p = 1.47e−13), proteinaceous extracellular matrix (p = 1.56e−05), from complete. Under such a situation, the aims of the present study
and plasma membrane (p = 3.88e − 03). With respect to molecular were to summarize the most reliable gene set associated with endome-
function, the enriched terms were receptor binding (p = 7.76e−12), triosis and to predict novel candidate genes that have not been reported
protein binding (p = 8.27e − 09), binding (p = 1.03e − 05), signal before.
transducer activity (p = 1.75e−05), transcription factor activity (p = Initially, we performed a systematic analysis of endometriosis-relat-
1.92e−04), receptor activity (p = 7.82e−04), and calcium ion binding ed genes using text mining. After manual curation, we identified a total
(p = 8.96e − 03). Pathway analysis was performed using the KEGG of 1531 genes. “The wisdom of crowds” refers to the phenomenon in
pathway database. Enriched pathways were: cytokine-cytokine recep- which the collective knowledge of a community is greater than the
tor interaction (p = 3.62e − 08), steroid hormone biosynthesis (p = knowledge of any individual [24]. Based on this concept, in the present
3.04e−06), and apoptosis (p = 9.39e−05) (Fig. 3B). study, taking texting results as input, we proposed a gene filtering pro-
Additionally, gene network was constructed by using the STRING cess in a meta-analysis-like manner by computing the likelihood of
software by integrate publicly available interaction data. With the com- finding more than expected occurrences for every gene across the dis-
bined score being set to 0.9, we obtained a gene network consisting of ease-centered subset of the PubMed database. Our hypothesis is that
94 nodes connected via 314 edges (Fig. 3C). Topological analysis indi- those genes most repeatedly mentioned across a large body of publica-
cated that the network has some nodes that are highly connected com- tions on endometriosis might be data-driven causal endometriosis
pared to others. These highly connected nodes are known as hub genes. genes. In this process, we detected 121 genes that reached the statisti-
Using a defined cut-off value, we identified 5 hub genes: TP53 (tumor cally significant threshold (adjusted p b 0.01). These genes may serve
protein p53), VEGFA (vascular endothelial growth factor A), AKT1 (v- as a highly reliable gene set for endometriosis.

Fig. 4. Top 100 novel candidate genes for endometriosis prioritized by the Endeavour software. The full human genome was scanned. Rank ratios for 6 data sources (gene ontology, protein
domains from InterPro, KEGG pathway, microarray expression, gene network from STRING and transcriptional motifs from TRANSFAC) were shown as a heatmap. The integrated rank was
labeled on the left of the heatmap.
156 J.-L. Liu, M. Zhao / Genomics 108 (2016) 151–157

is a well-characterized pro-inflammatory cytokine implicated with en-


dometriosis [51]. A recent study has shown that IL6 was increased in en-
dometrial stromal cells isolated from the endometrial biopsies of
women with endometriosis compared to healthy controls [52]. IL6 con-
tributes to pathogenesis of endometriosis through the activation of sig-
nal transducer and activator of transcription (STAT) family of
transcription factors [53]. These data provide clues for the multiple
mechanisms hypothesized to be responsible for the establishment of ec-
topic endometrial tissues, including the migration, implantation, surviv-
al and proliferation of the ectopic endometrial cells.
It has been well established that genes involved in the same disease
usually have a large portion of shared annotations across many data-
bases. Hence, using the reliable 121 genes associated with endometri-
osis as “seed”, we were able to predict novel candidate genes. So far,
several computational methods for gene prioritization have been devel-
oped [54], which are suitable for this task. In the present study, we chose
the Endeavour software, because it is an easy-to-use online tool [55] and
performs best in an unbiased evaluation of similar tools [56]. The En-
deavour tool was configured to integrate 6 data sources: gene ontology,
protein domains from InterPro, KEGG pathway, microarray expression,
gene network from STRING and transcriptional motifs from TRANSFAC.
By scanning the full human genome, we made a list of 100 most prom-
ising candidate genes. These genes deserve further investigation. Addi-
tionally, we also used the raw text mining data (1531 genes) as the
Fig. 5. Receiver operating characteristic curves (ROC) for gene prioritization results from
the Endeavour software. The blue curve was generated using raw text mining data and training set and performed gene prioritization by using the Endeavour
the red curve was generated using filtered data. AUC, area under ROC curve. software with the same parameters. The outperformance of our filtered
data was noted in term of the area under the ROC curve. This result may
provide validity of our filtering process to select highly reliable genes.
In conclusion, in the present study we generated a highly reliable set
Based on gene ontology analysis, a total of 31 terms were significant- of endometriosis-related genes by statistical test. Characterization of
ly enriched among these 121 genes, including signal transduction, cell this gene set was conducted by gene ontology, pathway and network
communication, cell-cell signaling, lipid metabolic process, response analysis. This gene set was further used as “seed” to predict novel candi-
to stress, cell proliferation, cell differentiation, cell death, extracellular date genes. Our study provides in-depth insights into the molecular
space, receptor binding, and transcription factor activity. Pathway anal- mechanism underlying pathogenesis of endometriosis.
ysis revealed that cytokine-cytokine receptor interaction, steroid hor- Supplementary data to this article can be found online at doi:10.
mone biosynthesis, and apoptosis were significantly enriched. 1016/j.ygeno.2016.10.003.
In addition, we constructed a gene network by using gene-gene in-
teraction data available in the STRING database. We found that TP53,
Conflict of interest
VEGFA, AKT1, MMP9 and IL6 were hub genes of this network. The hub
genes are likely more important than other genes due to their key posi-
The authors have declared that no competing interests exist.
tions in the network. TP53 gene is a tumor suppressor gene and plays an
important role in the regulation of cell growth and prevention of carci-
nogenesis [25]. TP53 located on chromosome 17 and aneuploidy of this Acknowledgements
chromosome had occurred during the development of endometriosis
[26]. A significant decrease of TP53 protein was observed in ovarian le- This work was supported by National Natural Science Foundation of
sions compared with eutopic endometrium [27]. Additionally, a com- China (grant number 31271602 to Ji-Long Liu) (http://www.nsfc.gov.
mon SNP Arg72Pro (rs1042522) has been demonstrated to be cn/).
associated with the susceptibility to endometriosis [28–34]. The ectopic
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