Endo Battery

Fast Charge: Why Ultra-Accurate Liquid Biopsies May Change Diagnosis, Treatment, And Trust In Women’s Health

• Alanna • Episode 188

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What if a drop of blood or menstrual fluid could reveal the hidden biology driving endometriosis? We sit down with Dr. Canio Martinelli, OBGYN and oncology educator, to unpack how liquid biopsy is moving from bold idea to practical tool—and what it will take to make it safe, accurate, and accessible. From circulating “fingerprints” to AI-enhanced signal detection, we chart a path toward earlier detection, better monitoring, and more precise interventions.

We break the science into clear layers: genomics, epigenetics like DNA methylation, RNA transcription, and protein function. That stack of information explains why one-size-fits-all tests fall short and why a multi-omic signature could finally reflect the reality patients live with—wildly variable symptoms, misdiagnosis, and years of unanswered questions. We also tackle the stakes of accuracy. FDA-grade standards for AI diagnostics force meaningful validation so a negative result doesn’t silence someone’s pain or delay necessary care. Noninvasive testing should expand options and trust, not replace clinical judgment or a skilled surgeon when they’re needed.

Beyond diagnosis, we explore how liquid biopsy can accelerate research and drug development, enrich clinical trials with likely responders, and even enable molecular-guided surgery to remove microscopic disease more precisely. We talk equity and access through affordable sensors, transparent reporting, and patient education that demystifies what results mean. The takeaway is both practical and hopeful: rigorous science, ethical design, and patient-centered choices can change outcomes in women’s health. If this conversation gave you new language, new questions, or a new sense of possibility, follow the show, share it with someone who needs validation today, and leave a review to help more listeners find these tools and this community.

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Speaker:

Welcome to Endo Battery Fast Charged, a series dedicated to keeping you informed and empowered in the realm of endometriosis. Teaming up with board certified patient advocates, we bring you the latest articles, research, and insights to equip you with accurate information and a deeper understanding. Whether you're expanding your knowledge, staying updated, or seeking clarity, you're in the right place. I'm your host, Alanna, and this is Endo battery Fast Charged, charging and empowering your life with knowledge. Welcome back to Endo Battery Fast Charge, where we power through the latest research shaping endometriosis in women's health. I couldn't be more excited to have our very first guest on this series, Dr. Canio Martinelli, an OBGYN specialist and the head of clinical program at Savaro Health Research Organization at Temple University. Dr. Martinelli, recently named FDAA AACR Oncology Educational Fellow, is at the forefront of translating cutting-edge science into real-world impact. His work connects emerging research, clinical care, and the future treatment for people with endometriosis, helping us better understand where innovation can truly change lives. And just as a friendly reminder, correlation does not equal causation. So let's keep our curiosity fully charged, but stay grounded as we dig in. You know how I always say grab a cup of coffee or a cup of tea and join me at the table before we get started? Well, what if that cup could do more than just taste good? Meet Strong Coffee Company, my little secret weapon. It's premium instant coffee loaded with protein MCTs and adaptogens so you get smooth energy, sharp focus, and none of that jittery crash. Basically, it's coffee that actually shows up for you. Use my promo code Endo battery for an exclusive 20% discount. And yes, when you do, you're helping me keep these expert conversations brewing here at Endo Battery. So go on, grab your cup, power up by going to strongcoffeecompany.com and using the code EndoBattery. And let's make this episode even better. Let's get into this. Thank you so much, Canio, for joining me and sitting down and going over this research. With all the advances coming up, what is one of the things that you've been researching that is exciting for people across all aspects of women's healthcare?

Speaker 1:

Thank you so much for your incredible question. Because uh we're always looking for something that can be really game-changing. And one of the things that has been game-changing is liquid biopsy. It's a kind of uh strange concept because whenever we think about biopsy, it's something that you do in medicine when uh you took a solid part of the body out of the body of the patient, and then you examine on a pathological uh examination and you get the report. Here the liquid biopsy is a conceptually a completely another stuff because uh you can get some sample of any liquid of the body. Basically, the the project started with blood, but it can be saliva, urine, it can be tears. And the idea is uh being able to find in that sample something that we can use to better understand the disease, but also to improve our management in uh in healthcare. And that's the beauty of things, because, for example, how is it possible that if you have an ovarian cancer or endometrial endometriosis, you know, those are diseases that start in the ovary, in the peritoneum, or uh like uh all over the body, even for endometriosis. But uh how do you get sample of that disease in the blood, for example, on or in the menstruation on in the uterine bleeding? Uh well, the beauty of this is that first of all you need to understand the biology of the disease. Because whenever you develop a tool in medicine, uh it's not just enough developing the tool. It needs to be then uh you need to show how you want to implement the management within with the new tool. Because if you introduce something new, it doesn't mean that's necessary much better than what you're already doing. And now we are in a point of healthcare, especially in oncology, where the where innovation really brought us in in a fantastic period of humanity where we can really, there are still very, very uh fatal diseases, especially when you get ovarian cancer late time. But uh most of the time, if you can get them, you can still give hope to people and give nice uh chances. So whatever you are doing now has to be specific for specific patients that needs to for sure give much uh more benefit than before. So you cannot just try. Uh in the liquid biopsy, it's it's extremely innovative stuff because uh you can be less invasive because you can take, you know, uterine bleeding or blood sample, and you can do extremely fine diagnosis. It's like when you have right now, if you have a cholesterol, you just need to take a blood sample, right? And cholesterol is something that navigates and swim in the blood. Same stuff we need to find for endometriosis of variant cancer, endometrial cancer, generally with the cancer works much better. Something that circulates in these uh in these samples and being able to detect them and use that kind of detection to understand the disease and even to develop something new. So, if I want to have a kind of metaphor, I would say that it's like for the FBI, you know, using fingerprints to find criminals. The liquid biopsy is exactly the same thing. We will use fingerprints that cancer endometriosis live in the in the in the blood in order to detect them as early as we can, right in the less invasive way possible. But if you think about FBI 200 years ago, it it didn't exist, of course, but let's say that it exists. If you wanted to catch a criminal by using fingerprints, it would have been impossible because you didn't even have the fingerprints. Now everybody coming to US didn't need to give, you know, to record fingerprints, so it's very easy. What we are doing right now in science is that for liquid biopsy, right now detecting the fingerprints of uh uh circulating fingerprints of cancers or very, very high inflammatory diseases such as endometriosis. Yeah. And now we are developing that you can look at different reviews and editorial that we we wrote. One is exactly liquid biopsy in gynaecological cancer. The other one is called uh cancer in a drop. And now we are developing together with uh a fantastic team from Italy new sensors in order to detect this kind of uh fingerprints, this is uh from different uh samples from women in order even to try to develop uh sensors that are cheap so you can uh let everybody use uh the new technology.

Speaker:

What is like the control group for that and like what's the accuracy of it so far?

Speaker 1:

Exactly. So whenever you do that, you have a population. We are right now in the in the in a phase where we are training the system.

Speaker:

Okay.

Speaker 1:

There are already some commercial available um like uh especially for endometriosis, especially in US, uh tools that you can use to detect endometriosis. Some of them with even uh AI powered, they say that they can have an accuracy of 96%. The thing is that, and that's another actually critical paper that we are working on. There are different kinds of papers, you know better than me. Is that FDA, in order to approve AI liquid biopsy test, you need to show an accuracy that is higher than 99%. And I think that FDA was incredibly smart this time because they said, okay, you wanna do that, but you need to show that it's incredibly accurate. Otherwise, I'm not gonna give you the FDA approval. That's why lots of right now liquid biopsy tools they don't have they don't have FDA approval. I think that's very important because what is I'm gonna ask you this question actually to you. Like let's say that you're a young girl and you have pain, you believe you are of endometriosis and you live in a place in the US all over the world, but you don't have an easy access to uh like real specialist, you know, of endometriosis. And you feel pain, you feel pain, you go to a doctor and he says, uh, you don't have anything, don't worry, you are a woman. Uh and then you take the test, and the test is gonna give you what we call uh false negative. So the test is gonna, because the accuracy is not very, very high, the test is gonna tell you there is a risk that tells the test tells you you you don't have the disease. At that point, you're gonna uh basically say to that woman that your life, her life is gonna be destroyed for the rest of the life because uh she will have the confirmation that she does not have any problem and she will convince herself that she needs to feel that pain. So again, whenever there is this new sexy stuff in science, validation is first step. Second step is how can I introduce that without uh creating critical problem for people? Because you know, when you when you see the test and the test test is negative, you don't think about okay, what's the accuracy rate? That's a question that you uh are uh like right now, you're making. But lots of people they don't think about that because when they are in a fight or flight mode, they just are focused on something, they don't have the calm to to really be rational things. So we need to be very, very careful, especially when people want to make money out of this. So we need to stand up for people who says, okay, FDA did an incredible job here, I have to say that.

Speaker:

Right. So this study is essentially is it going to be an analyzing, like creating a tool that analyzes like the DNA for inflammatory markers and genetic mutations, or is it is it a doing it through different sequencing?

Speaker 1:

Well, let's say that we are working on different kinds of sensor. One of the most two of the most promising one. One is working on the ventilation of the DNA. We know that there is the genomics that's actually the omic related to the sequence of the DNA. But the DNA is not just something that stays there, it's uh it's a living stuff, it's something they change, something that got modified. And so we can have the same DNA, but there could be different modifications. So it's called epigenetics. Right. So even if you have the same genomics, it doesn't mean that you're gonna be the same. Because the modification of the DNA, in this case, uh epigenetic modification, can change the way the gene expresses themselves into proteins, and then again there will be a modification of the proteins, and the way they are modified will determine the function of the proteins. And if you put all of these layers together, you're going to create a unique pattern, not just as uh like uh phenotypically human, but even from a functional biological distinction, and that's the thing. So being able to see the methylation pattern of all the DNA can give nice information, especially related to inflammation, like inflammatory disease such as endometriosis, because they're gonna leave a fit like we said, a fingerprint somehow. Like if you don't wanna commit any like a problem, you just don't create problem. If you do something, you can hide, but someone is gonna find you. That's we are in that phase. We're gonna find we know that endometriosis is something invasive, it's something that whenever you know it got attached to somewhere in the body, it has to do something. Maybe the signal is very, very low, and when the signal is low, we can use AI stuff to like enhance the signal, but we're getting to that.

Speaker:

Interesting. I think what's important too, and what you're saying is like the FDA did a good job in this, is that if they're giving false negatives, that also plays into the mental aspect of things, like how that kind of disrupts our cognitive function in a way, and and our mental health and everything else. Like there's there's something to be said about making sure something is very accurate and giving voice to what we're going through. And that's what you're saying is like you're getting to a point where this is accurate diagnosis without the invasive surgery.

Speaker 1:

Absolutely. And uh, it's even about uh, you know, it's uh it's a way to explain people how really healthcare is, because uh let's say that you don't have absolutely any access to healthcare, you are in a rural place in the world, and that's the only chance you have, you know, maybe you can use it, but being aware that if it's negative, it's not necessarily negative.

Speaker:

Right.

Speaker 1:

But if you have the chance to get access to uh a very experienced surgeon, then I won't spend any money on this stuff. I will just get to the experienced surgeon. And uh let me share with you with this. Uh my mom is uh right now, actually, the issue is gonna turn 70 years old. She is a doctor and she's an old school doctor. She always tells me you have to listen to patients. If there is a problem, if they say that there is a problem, the problem is there. Yes, whatever it is, you know, it can be organic, mental, whatever it is, but there is a problem. If you want to convince the patient that she does not have a problem, that's because you're not able to find out what the problem is. Yeah, that's okay. But you need to recognize, to assess the presence of the problem. You cannot solve it. You send to another uh colleague, you remove something, you do, you organize something, you go to the you can instantly say, you know, no, as a doctor, we believe we need to be uh superhuman. Absolutely not. Need to be sincere to people. So, okay, maybe I don't know that. I'm sorry. I understand that there is a problem, I can feel it. You tell me, actually, so you know, you're telling me right. Uh I can I I'm gonna help you, I'm gonna do the best I can in my knowledge and my connection. And uh at the end, again, everything cool in tech and in science needs to be damn fit in the in the in the right way.

Speaker:

Yeah. Well, it's also a tool of validation. I think that's kind of a big thing for a lot of people because I mean this is like it's a tool that we could utilize when we are seeing providers who don't really know a lot about endometriosis. I think that's such a cool avenue for us to be able to go into with the caveat of saying we don't always know for certain 100% that it's not there. Right.

Speaker 1:

That means that whenever you want to use a tool, then uh without the physician in the loop, people need to be aware about how it works. I know that self-education is you know hard to do. If we don't talk about medicine or something else like finance, engineering, you know, I can try to self-educate me, but then you need to trust patient advisor, someone else that that already went through that and then uh you know always talk to people.

Speaker:

Yeah. What advances will this bring for research, though? I think that's kind of an important step, is like research is great, but how will it advance more research? What are what do you think the goal would be for that?

Speaker 1:

Regarding liquid biopsy is something that is already happening in uh in uh in the oncology field, uh, and it's something that is already here. So it's happening today. If I'm able to detect cancer earlier, um I'm not just able to use different treatments or change the management, but also able to even give uh the green light for some drugs that are being uh developing right now. Because uh, whenever you introduce new drug, you need to validate those through uh years and years of studies, like five, six years, and they have to follow up. And then, you know, during the validation of the new drug, only the people that fit within the trial can benefit from the new drug. There is lots of people that won't benefit from that drug unless, you know, until the the study will be over. In this way, is something that is working on this. If we find, and we already found in some specific case a target in the liquid biopsy that are related with clinical outcomes, so they really have a clinical meaning, it means that I can accelerate, I can speed up the process of validation of drug. So it's gonna give a great boost even uh in uh in drug uh validation and production. Basically, the goal is even uh if we know the fingerprints, every cancer can give a different fingerprint. So we can even study the biology behind that specific cancer and being able even to do what we call molecular guided surgery. So whenever you open a patient, you just not remove the organ or the tissue, you are able to see the cancer cells, you're able to visually see the cancer cells. Okay, I'm gonna remove all the tiny little places.

Speaker:

Interesting. There's so much hope for so many people. It's just amazing what you're able to do with tools that have been and and creativity, you know. Are there studies that you are currently working on that are gonna push the boundaries a little bit in patient-centered care or diagnosis?

Speaker 1:

And you can talk about because that's always so there is a molecular medicine project ongoing in my center, uh, especially for oncological cancers. I may not say the name of the target, but it's something that has to do with cell cycling and uh translation of the proteins. The idea here is the experimental studies right now. We maybe have found something uh that if we target can slow down uh the oncogenesis process in specific cancers. So it's just a new, you know, a new target that may be useful even for synthesizing drug resistance because uh when we talk about AI, when we talk about the tools, it's something that uh we are doing in order to enhance the ability of humans to cure and treat patterns to see new data. But then there is uh the other part of the science, so generate new data, not just being able to analyze the existing one. Uh this is still today, there are something that we are advancing with the eye, but still kind of analogical. So it means that whenever we found a pattern, then we need to modify the cells in lab, and then we need to see what's happening after we do this kind of genetic editing, and then we need to skip and next phases, and then we will get to the patient. That's the part of the research that's very, very exhausting because uh whenever you modify a cell, you never know what's happening.

Speaker:

Right.

Speaker 1:

One gene can have uh a role in one cancer, and there's a complete another role in another cancer, and then there is another one gene, as we said, is it's not just one, but then you have to look at the epigenetics and the way you get transcripted in RNA and the gatting gets translated in proteins, and how the proteins get modified. So the goal here is uh trying to put all as again all the layers together, otherwise we won't understand very precisely what's going on.

Speaker:

Right. Yeah. There's so many layers to all of this research. They're insane. And I'm excited to see like where that goes because you know, we I feel like a lot of times we talk about needing more research, but we there's research happening, we just don't know it. We don't know what's being done. And yet there's people that are starting to pay more and more attention to things like endometriosis and cancers and like specifically women's health-related research. And I there's people that are passionate, like you, who are putting things together. We just aren't always aware of it. And it's going to change the trajectory of those living with this disease because earlier diagnosis, better care, better treatment, better precision in surgery, what uh maybe even future is reversing some of that inflammatory markers.

Speaker 1:

Exactly. Yes, you're getting there. See, I mean, uh that that's the real goal. Like we publish this these um these studies called endometriosis cancer mimicking, is on it's in uh the annals of oncology journal. And uh the cool thing about that is uh endometriosis. I'm sorry if I say cool, but it's uh scientifically cool. Let's say that it's not a is that endometriosis looks like it behaves like a cancer, but it's not a cancer, but has some traits of a cancer. And as you said, when it comes to cancer, it's a very paradoxical stuff because uh cancer cells discovered how to become immortal because uh they are able to proliferate, to invade, to move, to metastasize, so they are super, you know, supercells. And they can live forever, actually, but there is one problem they will die once they will kill the organism they are into. So it's kind of the price to discover immortality is actually death. And it's something that makes me reflect a lot because maybe humans not made for immortality because the price to pay is is uh is death. There have been lots of uh research right now in longevity, aging, trying to be immortal and blah blah blah. But whenever you act and you try to modify some natural processing, such as aging, you don't know what's happening there. That's why most of the anti-aging stuff in the long term or hormone treatment long term have been associated with cancer issues and cancer risk because nature is a very specific way to work and to function. And whenever you want to change it, something may happen.

Speaker:

Right, right. And it I feel like endometriosis is definitely always leaving us on this path of like which way is it gonna go? Like it's not something that is linear, it plays by its own rules. Exactly.

Speaker 1:

That's something that science learned from patient because uh patient understood that much earlier than uh physician and scientists. Whenever you talk with the patient with endometriosis, you know that her story is completely different than someone else. Someone has a very small lesion and huge pain, someone has a very large lesion and like very, very soft pain. Someone has fertility problems, other ones has intestinal bowel problems. And then there was a case that was a case in Italy actually. This girl has endometriosis in the brain. And so it happened, you know, that during the period uh uh this this brain lesion started to bleed, and she started to have uh epilepsy uh seizure, and then after the period everything was okay, everybody was uh ready to start uh for you know they thought it could be cancer. They started to do the they wanted to do the excision surgery in the brain, that's very, very hard and debilitating. But somehow there was a discussion where, you know, it was uh several years ago. So what happened is uh someone noticed the correlation with the periods that it may be endometriosis. And so they put uh the patient under hormonal treatment to stop the let's say the the period, the cycle, and she was completely fine. So it was endometriosis, brain endometriosis. So you see that we are talking about endometriosis as a single disease, but already has been years that patient already telling us that endometriosis is not a single disease, so it's not something that we discover like, oh, we're genius. No, we're just opening the eyes. We just right now, what we need to do is finding the resources, the team, the collaboration to keep working on that. And that's the paper we're talking about. We did a research and we saw that endometriosis is like having a car for each patient. You know, the way the car goes and depends, the way you use uh the pedals, the way you drive, uh the gears, and uh so you can shift whatever she wants. And uh the question is there is the way to detect and predict the behavior? There may be, because in the study what we propose is that we studied all the possible pathways that the pneumatic cells are can be possibly activated, doesn't mean that the pathways are active at the same time altogether, right? So now the goal is trying to, and we are starting a collaboration with the biotech, I cannot say the name, but uh, we're starting a collaboration to see through specific analysis whether these uh functionality are like uh specifically related to specific clinical symptoms. Interesting. So we can go on the way back, so from the clinical symptoms, we can then uh relate with the biology of the single cells.

Speaker:

Fascinating. We're changing so much over here in that world. Thank you, Kanye, for just sitting down and going over this research. I hope, I hope that talking to you and people being in this conversation and hearing this gives them hope that there's more to look forward to in endometriosis research and care and in women's health and patient outcomes, not just looking at surgery, but looking at the whole picture. You are doing a phen phenomenal job of thinking outside of the box and what really matters not only to the patient but to the provider and looking at it as a collective effort to create better health care for everyone. And so thanks for breaking this research down. Thank you for doing it. Thanks for you know being passionate about this because this is what's gonna change the future. Thank you.

Speaker 1:

I wanna let me let me thank you because here you're doing an incredible job too. If we will be successful, it's because everybody will work together and uh we will commit to the same challenge. And uh, the history of the world is showing us that when people work together, we can do that. Alone, of course, you won't go farther.

Speaker:

Right?

Speaker 1:

No, just thank you so much.

Speaker:

Yes, thank you. And I always love talking to you and I love spending time with you, so it's just a pleasure all around to be able to do this. But remember everyone, knowledge is power, and what you do with that power is create change. So until next time, continue advocating for you and for others.