151
|
Focal adenomyosis of the outer myometrium and deep infiltrating endometriosis severity. Fertil Steril 2020; 114:818-827. [PMID: 32741618 DOI: 10.1016/j.fertnstert.2020.05.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/28/2020] [Accepted: 05/02/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To determine whether the presence of focal adenomyosis of the outer myometrium (FAOM) at preoperative magnetic resonance imaging is associated with the severity of deep infiltrating endometriosis. DESIGN Observational cross-sectional study involving 255 symptomatic deep infiltrating endometriosis patients. Comparisons were performed according to the presence of FAOM. SETTING University hospital. PATIENT(S) Women with a preoperative magnetic resonance imaging and complete surgical exeresis of endometriotic lesions with histologically documented deep infiltrating endometriosis. INTERVENTION(S) Surgical management for deep infiltrating endometriosis. MAIN OUTCOME MEASURE(S) The presence of multiple deep infiltrating endometriosis lesions, the mean number and location of deep infiltrating endometriosis lesions, and the mean total revised American Society for Reproductive Medicine scores. RESULT(S) The prevalence of FAOM at preoperative magnetic resonance imaging in the 255 patients with deep infiltrating endometriosis was 56.5%. The mean number of deep infiltrating endometriosis lesions was significantly higher in the FAOM(+) group than in the FAOM(-) group: 3.5 ± 2.1 vs. 2.2 ± 1.5. The mean total revised American Society for Reproductive Medicine score was higher in case of FOAM coexisting with deep infiltrating endometriosis. After adjusting for confounding factors, the presence of FAOM was significantly associated with multiple deep lesions. CONCLUSION(S) FAOM was significantly associated with greater deep infiltrating endometriosis severity. This needs to be integrated into the management strategy. Furthermore, a pathogenic link between deep infiltrating endometriosis and FAOM cannot be excluded.
Collapse
|
152
|
Mosher AA, Tsoulis MW, Lim J, Tan C, Agarwal SK, Leyland NA, Foster WG. Melatonin activity and receptor expression in endometrial tissue and endometriosis. Hum Reprod 2020; 34:1215-1224. [PMID: 31211323 DOI: 10.1093/humrep/dez082] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/22/2019] [Accepted: 05/02/2019] [Indexed: 01/21/2023] Open
Abstract
STUDY QUESTION Are melatonin receptors (melatonin receptor 1A (MR1A) and melatonin receptor 1B (MR1B)) expressed in human endometrium and endometriotic tissue, and does melatonin affect endometrial cell proliferation? SUMMARY ANSWER Melatonin receptors are expressed in human eutopic endometrium, endometriomas and peritoneal lesions, although to different extents, and melatonin treatment attenuated estradiol-induced endometrial epithelial cell proliferation in culture. WHAT IS KNOWN ALREADY Melatonin decreased endometriotic lesion volume in a rat model of endometriosis. Melatonin treatment reduced pain scores in and analgesic use by women with endometriosis. STUDY DESIGN, SIZE, DURATION Basic science study using human endometrial tissue and an endometrial epithelial cell line. PARTICIPANTS/MATERIALS, SETTING, METHODS Measurement of melatonin receptor expression (mRNA and protein) in women with surgically confirmed endometriosis (endometrioma (n = 20) or peritoneal lesion (n = 11) alone) and women without surgical evidence of endometriosis (control, n = 15). Collection of endometrial and endometriotic tissue samples, gynecologic history and demographic information. Quantification of estradiol (1.0 nM) and melatonin (0.1 nM-1.0 μM) ± estradiol-induced endometrial epithelial cell proliferation in cultures of endometrial epithelial cells (CRL-1671) following 24 and 48 hours of culture. MAIN RESULTS AND THE ROLE OF CHANCE MR1A and MR1B were localized by immunohistochemistry in glandular epithelial cells of endometrial biopsies from women with and without endometriosis. Both receptors were expressed in eutopic and ectopic endometrial tissue. mRNA expression of MR1A and MR1B was significantly greater in peritoneal lesions than in either endometriomas or eutopic endometrium. However, protein expression of MR1A was decreased in peritoneal lesions compared to control eutopic endometrium, whereas MR1B expression did not differ between the groups. Melatonin (0.1 nM-1.0 μM) treatment inhibited estradiol (1.0 nM)-induced endometrial epithelial cell proliferation at 48 hours but not 24 hours of culture. LIMITATIONS, REASONS FOR CAUTION Beneficial effects of melatonin seen in culture have yet to be comprehensively evaluated in women with endometriosis. WIDER IMPLICATIONS OF THE FINDINGS Our data suggest that melatonin may be useful as an adjunct to current endometriosis treatments. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by the Canadian Institutes of Health Research (grant MOP142230 to W.G.F.). A.A.M. is supported by a resident research grant through the Physicians Services Incorporated Foundation. The authors have no conflicts of interest.
Collapse
Affiliation(s)
- A A Mosher
- Department of Obstetrics and Gynaecology, McMaster University, Hamilton, ON, Canada
| | - M W Tsoulis
- Department of Obstetrics and Gynaecology, McMaster University, Hamilton, ON, Canada
| | - J Lim
- Department of Obstetrics and Gynaecology, McMaster University, Hamilton, ON, Canada
| | - C Tan
- Department of Obstetrics and Gynaecology, McMaster University, Hamilton, ON, Canada
| | - S K Agarwal
- Center for Endometriosis Research and Treatment, University of California San Diego, La Jolla, CA, USA
| | - N A Leyland
- Department of Obstetrics and Gynaecology, McMaster University, Hamilton, ON, Canada
| | - W G Foster
- Department of Obstetrics and Gynaecology, McMaster University, Hamilton, ON, Canada.,Center for Endometriosis Research and Treatment, University of California San Diego, La Jolla, CA, USA
| |
Collapse
|
153
|
Vercellini P, Sergenti G, Buggio L, Frattaruolo MP, Dridi D, Berlanda N. Advances in the medical management of bowel endometriosis. Best Pract Res Clin Obstet Gynaecol 2020; 71:78-99. [PMID: 32680785 DOI: 10.1016/j.bpobgyn.2020.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 12/29/2022]
Abstract
Endometriosis infiltrating the bowel can be treated medically in accurately selected women not seeking conception and without overt obstructive symptomatology. When the rectosigmoid junction is involved, the probabilities of intestinal symptoms relief, undergoing surgery after treatment failure, and developing bowel obstruction during hormonal treatment are around 70%, 10%, and 1-2%, respectively. When the lesion infiltrates exclusively the mid-rectum, thus in cases of true rectovaginal endometriosis, the probabilities of intestinal symptoms relief and undergoing surgery are about 80% and 3%, respectively. Endometriotic obstructions of the rectal ampulla have not been reported. A rectosigmoidoscopy or colonoscopy should be performed systematically before starting medical therapies, also to rule out malignant tumours arising from the intestinal mucosa. Progestogens are safe, generally effective, well-tolerated, inexpensive, and should be considered as first-line medications for bowel endometriosis. Independently of symptom relief, intestinal lesions should be checked periodically to exclude nodule progression during hormonal treatment.
Collapse
Affiliation(s)
- Paolo Vercellini
- Department of Clinical Sciences and Community Health, Università degli Studi, Via Commenda, Milan, Italy; Fondazione Ca' Granda Ospedale Maggiore Policlinico, Via Commenda, 12-20122, Milan, Italy.
| | - Greta Sergenti
- Department of Clinical Sciences and Community Health, Università degli Studi, Via Commenda, Milan, Italy
| | - Laura Buggio
- Fondazione Ca' Granda Ospedale Maggiore Policlinico, Via Commenda, 12-20122, Milan, Italy
| | - Maria Pina Frattaruolo
- Fondazione Ca' Granda Ospedale Maggiore Policlinico, Via Commenda, 12-20122, Milan, Italy
| | - Dhouha Dridi
- Department of Clinical Sciences and Community Health, Università degli Studi, Via Commenda, Milan, Italy; Fondazione Ca' Granda Ospedale Maggiore Policlinico, Via Commenda, 12-20122, Milan, Italy
| | - Nicola Berlanda
- Fondazione Ca' Granda Ospedale Maggiore Policlinico, Via Commenda, 12-20122, Milan, Italy
| |
Collapse
|
154
|
Schippert C, Witte Y, Bartels J, Garcia-Rocha GJ, Jentschke M, Hillemanns P, Kundu S. Reproductive capacity and recurrence of disease after surgery for moderate and severe endometriosis - a retrospective single center analysis. BMC Womens Health 2020; 20:144. [PMID: 32660473 PMCID: PMC7358195 DOI: 10.1186/s12905-020-01016-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 07/07/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Endometriosis can be associated with considerable pain and sterility. After surgical excision of moderate or severe endometriosis lesions, the rate of recurrence reaches up to 67%. The objective of this retrospective study was to establish the recurrence and pregnancy rates following surgical resection of stage III/IV endometriosis lesions. Indications for operation were endometriosis symptoms, sonographic findings and/or infertility. METHODS A total of 456 patients who underwent stage III/IV endometriosis surgery between 2004 and 2014 were sent a questionnaire relating to their postoperative medical treatment, pregnancies, relief of symptoms and recurrence. Responses of 206 patients (45.2%) and their clinical data were analysed for this study. RESULTS A total of 66.5% (N = 137) of patients had stage III disease, and 33.5% (N = 69) had stage IV disease. The average age was 37 years (17-59). A total of 63.1% (N = 130) of surgeries were performed by laparoscopy, 21.8% (N = 45) were performed by laparotomy and 15% (N = 31) were performed by conversion. Complete resection of endometriosis lesions was achieved in 90.8% of patients (N = 187). After surgery, 48.5% (N = 100) of the women did not receive hormonal treatment; the main reason was the desire for children in 53%. Complete or partial relief in complaints was achieved in 93.2% (N = 192). The rate of recurrence was 21.8% (N = 45). The statistically significant factors that was associated with a higher risk to develop recurrence was an age < 35 (p < 0.005). After surgery, 65.8% (79/120) of patients who wished to have children became pregnant. There was a statistically significant association among a higher postoperative pregnancy rate and age < 35 (p < 0.003) in multivariate logistic regression analysis and laparoscopic surgical access in univariate logistic regression analysis (p < 0.01). CONCLUSION We assessed the high percentage of complete or partial relief of symptoms of 93.2%, the high postoperative pregnancy rate of 65.8% and the low rate of recurrence of 21.8% compared to international literature to be very encouraging for women suffering from moderate and severe endometriosis. Though laparoscopy is considered the 'gold standard'of endometriosis surgery, laparotomy still may be indicated in patients with extensive endometriosis especially to preserve reproductive function.
Collapse
Affiliation(s)
- Cordula Schippert
- Department of Obstetrics and Gynaecology, Hanover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - Yvonne Witte
- Department of Obstetrics and Gynaecology, Hanover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Janina Bartels
- Department of Obstetrics and Gynaecology, Hanover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Guillermo-José Garcia-Rocha
- Department of Obstetrics and Gynaecology, Hanover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Matthias Jentschke
- Department of Obstetrics and Gynaecology, Hanover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Peter Hillemanns
- Department of Obstetrics and Gynaecology, Hanover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Sudip Kundu
- Department of Obstetrics and Gynaecology, Hanover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| |
Collapse
|
155
|
Della Corte L, Barra F, Mercorio A, Evangelisti G, Rapisarda AMC, Ferrero S, Bifulco G, Giampaolino P. Tolerability considerations for gonadotropin-releasing hormone analogues for endometriosis. Expert Opin Drug Metab Toxicol 2020; 16:759-768. [DOI: 10.1080/17425255.2020.1789591] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples “Federico II”, Naples, Italy
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (Dinogmi), University of Genoa, Italy
| | - Antonio Mercorio
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples “Federico II”, Naples, Italy
| | - Giulio Evangelisti
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (Dinogmi), University of Genoa, Italy
| | | | - Simone Ferrero
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (Dinogmi), University of Genoa, Italy
| | - Giuseppe Bifulco
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples “Federico II”, Naples, Italy
| | - Pierluigi Giampaolino
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| |
Collapse
|
156
|
Luo M, Cai X, Yan D, Liu X, Guo SW. Sodium tanshinone IIA sulfonate restrains fibrogenesis through induction of senescence in mice with induced deep endometriosis. Reprod Biomed Online 2020; 41:373-384. [PMID: 32651107 DOI: 10.1016/j.rbmo.2020.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/02/2020] [Accepted: 04/08/2020] [Indexed: 02/06/2023]
Abstract
RESEARCH QUESTION Does sodium tanshinone IIA sulfonate (STS) induce cellular senescence in endometriotic lesions and thus restrict lesional development and fibrogenesis in a recently established mouse model of deep endometriosis? DESIGN Prospective randomized animal experiment in which deep endometriosis was induced in female Balb/C mice, which were then randomly divided into three groups (low-dose STS, high-dose STS and inert vehicle control) and received treatment for 2 weeks. All mice were then sacrificed and their lesions excised and harvested. Lesion weight was quantified and all lesion samples were subjected to histochemical analysis of the extent of lesional fibrosis by Masson trichrome staining, and of cellular senescence by senescence-associated β-galactosidase (SA-β-gal), along with immunohistochemistry analyses of p53, CCN1, activate Salvador 1 (Sav1), hyaluronan synthase 2 (HAS2), survivin, granulocyte-macrophage colony-stimulating factor (GM-CSF) and CD163-positive M2 macrophages. Plasma P-selectin and hyaluronic acid levels were also quantified. Hotplate testing was also administered before the induction, then before and after treatment. RESULTS STS treatment resulted in significantly reduced lesion weight, stalled lesional fibrogenesis and improved hyperalgesia, seemingly through the induction of cellular senescence by activating p53, Sav1 and CCN1 while suppressing HAS2, survivin and GM-CSF, resulting in increased apoptosis and reduced lesional infiltration of alternatively activated macrophages. In addition, STS treatment significantly reduced the plasma concentration of P-selectin and hyaluronic acid, possibly leading to reduced lesional platelet aggregation. CONCLUSIONS STS appears to be a promising compound for treating endometriosis. The results suggest that senescence may restrict lesional progression and fibrogenesis, and targeting the senescence pathway may have desirable therapeutic potential.
Collapse
Affiliation(s)
- Min Luo
- Department of Obstetrics and Gynecology, Ningbo No. 7 Hospital, Ningbo Zhejiang 315200, China; These three authors contributed equally to this work
| | - Xianjun Cai
- Department of Obstetrics and Gynecology, Ningbo No. 7 Hospital, Ningbo Zhejiang 315200, China; These three authors contributed equally to this work
| | - Dingmin Yan
- Shanghai OB/GYN Hospital, Fudan University Shanghai 200090, China; These three authors contributed equally to this work
| | - Xishi Liu
- Shanghai OB/GYN Hospital, Fudan University Shanghai 200090, China; Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Fudan University Shanghai, China
| | - Sun-Wei Guo
- Shanghai OB/GYN Hospital, Fudan University Shanghai 200090, China; Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Fudan University Shanghai, China.
| |
Collapse
|
157
|
Harris A, McCaughey T, Tsaltas J, Davies-Tuck M, Ratner R, Najjar H, Barel O. Endometriosis-related pelvic pain following laparoscopic surgical treatment. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2020. [DOI: 10.1177/2284026520926038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Endometriosis is a common, often-debilitating disease, affecting women of reproductive age. Pain is a common symptom of the disease and is commonly treated by surgery, medical therapy, or a combination of the two. This study aimed to evaluate the rates of ongoing pain post laparoscopic excision and the risk factors for ongoing pain symptoms. Methods: This retrospective cohort study analyzed the medical records of all patients who underwent laparoscopic surgery for endometriosis in a large tertiary healthcare service in Australia between January 2009 and September 2016. Results were analyzed using SPSS statistics version 11. Results: A total of 972 patients met the inclusion criteria; of these, 398 had follow-up at our hospital network and were included in the final analysis. The median age was 34.5 years, 69.6% were of Caucasian ethnicity, and the median body mass index was 25.9; 70.6% of our patients reported decreased pain after surgery. Patients who suffered from chronic pain were twice as likely to experience ongoing pain, while patients with stage 3–4 endometriosis were found to have 65% reduced odds of pain at follow-up (95% confidence interval = 0.22–0.61, p < 0.001). In univariate analysis of non-Caucasian patients, those who had a specialist endometriosis surgeon perform the surgery had significantly higher incidence of symptom improvement (58% reduced odds of recurrent pain and 40% reduced odds, p < 0.05, accordingly). Conclusion: The prevalence and severity of pain associated with endometriosis mandates a thorough understanding of the effectiveness of current management. Our article highlights the utility of laparoscopic surgery in treating endometriosis-associated pain.
Collapse
Affiliation(s)
- Amani Harris
- Gynaecological Endoscopy and Endometriosis Surgery Unit, Monash Health and Monash University, Melbourne, VIC, Australia
| | - Tristan McCaughey
- Gynaecological Endoscopy and Endometriosis Surgery Unit, Monash Health and Monash University, Melbourne, VIC, Australia
- The Royal Women’s Hospital, Melbourne, VIC, Australia
| | - Jim Tsaltas
- Gynaecological Endoscopy and Endometriosis Surgery Unit, Monash Health and Monash University, Melbourne, VIC, Australia
- Melbourne IVF, Melbourne, VIC, Australia
| | - Miranda Davies-Tuck
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
| | - Roni Ratner
- Gynaecological Endoscopy and Endometriosis Surgery Unit, Monash Health and Monash University, Melbourne, VIC, Australia
| | - Haider Najjar
- Gynaecological Endoscopy and Endometriosis Surgery Unit, Monash Health and Monash University, Melbourne, VIC, Australia
- Melbourne IVF, Melbourne, VIC, Australia
| | - Oshri Barel
- Obstetrics and Gynecology, Assuta Medical Center, Ben-Gurion University of the Negev, Ashdod, Israel
- Assuta Ashdod University Hospital, Ashdod, Israel
| |
Collapse
|
158
|
Rius M, Gracia M, Ros C, Martínez-Zamora MÁ, deGuirior C, Quintas L, Carmona F. Impact of endometrioma surgery on ovarian reserve: a prospective, randomized, pilot study comparing stripping with CO 2 laser vaporization in patients with bilateral endometriomas. J Int Med Res 2020; 48:300060520927627. [PMID: 32527167 PMCID: PMC7294500 DOI: 10.1177/0300060520927627] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To assess ovarian reserve through antral follicle count (AFC) and ovarian volume (OV) determination after decapsulation (stripping technique) or CO2 laser vaporization in the surgical treatment of patients with bilateral ovarian endometriomas. Methods This prospective, randomized, blinded, self-controlled pilot study was set in a tertiary university hospital between January 2017 and December 2017, and included consecutive patients with bilateral ovarian endometriomas ≥3 cm. The study was registered with ClinicalTrials.gov under the title ‘Impact on ovarian reserve according to the type of ovarian endometrioma excision: laser versus conventional cystectomy’; NCT 03826355. For each patient, the endometrioma on one side was randomly selected to undergo CO2 laser vaporization and the contralateral endometrioma to undergo laparoscopic decapsulation. Results A total of 16 patients were included. There were no statistically significant between-group differences in OV and AFC levels at baseline. At the 6-month follow-up, OV and AFC levels were significantly higher in the laser-treated group versus the stripping technique. Conclusion Lower OV and AFC levels following excisional surgery for endometrioma versus CO2 laser vaporization suggest a higher impact on ovarian reserve after the stripping procedure.
Collapse
Affiliation(s)
- Mariona Rius
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Meritxell Gracia
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Cristina Ros
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | | | - Cristian deGuirior
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Lara Quintas
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Francisco Carmona
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| |
Collapse
|
159
|
Gornes H, Vaysse C, Leguevaque P, Gallini A, André B, Guerby P, Kirzin S, Suc B, Motton S, Rimailho J, Weyl A, Chantalat E. Identification of a group with high risk of postoperative complications after deep bowel endometriosis surgery: a retrospective study on 164 patients. Arch Gynecol Obstet 2020; 302:383-391. [PMID: 32500217 DOI: 10.1007/s00404-020-05604-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 05/15/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Identify a group with a high risk of postoperative complications after deep bowel endometriosis surgery. METHODS We conducted a retrospective study on patients treated from 2012 to 2018 in two departments of gynecological surgery at the Toulouse University Hospital, France. The postoperative complications were evaluated in relation to the surgical management, associated with or without non-digestive surgical procedures, initial disease and patient's characteristics. RESULTS 164 patients were included. A postoperative complication occurred in 37.8% (n = 62) of the cases and required a secondary surgery in 18.3% (n = 30) of the cases. In the univariate analysis, the risk of postoperative complications increased significantly in the presence of segmental resection, disease progression, and associated urinary tract procedure or vaginal incision. In the multivariate analysis, the risk of overall postoperative complications was associated with the surgical management (p = 0.013 and 0.017) and particularly in the presence of segmental resection [Odds Ratio (OR): 20.87; CI 95% (1.96-221.79)]. The risk of rectovaginal fistula increased in the presence of segmental resection [OR: 22.71; CI 95% (2.74-188.01)] as well as in vaginal incision [OR: 19.67; CI 95% (2.43-159.18); p = 0.005]. CONCLUSION The risk of overall postoperative complications and rectovaginal fistula in particular increases significantly in the presence of vaginal incision, segmental resection and urinary tract procedures after deep bowel endometriosis surgery.
Collapse
Affiliation(s)
- H Gornes
- Department of General and Gynecological Surgery, University Hospital Center (CHU)-Rangueil, 1 Avenue du Professeur Jean Poulhès, 31400, Toulouse, France
| | - C Vaysse
- Department of General and Gynecological Surgery, University Hospital Center (CHU)-Rangueil, 1 Avenue du Professeur Jean Poulhès, 31400, Toulouse, France
| | - P Leguevaque
- Department of General Gynecological Surgery and Breast Diseases, Clinique Pasteur - Toulouse, Toulouse, France
| | - A Gallini
- Epidemiology Department, Research Methodology Support Unit (USMR), Toulouse University Hospital Center, Toulouse, France
| | - B André
- Department of General and Gynecological Surgery, University Hospital Center (CHU)-Rangueil, 1 Avenue du Professeur Jean Poulhès, 31400, Toulouse, France
| | - P Guerby
- Department of Gynecological Surgery, University Hospital Center-Purpan, Hôpital Paule de Viguier, Toulouse, France
| | - S Kirzin
- Department of Digestive Surgery, University Hospital Center-Rangueil, Toulouse, France
| | - B Suc
- Department of Digestive Surgery, University Hospital Center-Rangueil, Toulouse, France
| | - S Motton
- Department of General and Gynecological Surgery, University Hospital Center (CHU)-Rangueil, 1 Avenue du Professeur Jean Poulhès, 31400, Toulouse, France
| | - J Rimailho
- Department of General and Gynecological Surgery, University Hospital Center (CHU)-Rangueil, 1 Avenue du Professeur Jean Poulhès, 31400, Toulouse, France
| | - A Weyl
- Department of General and Gynecological Surgery, University Hospital Center (CHU)-Rangueil, 1 Avenue du Professeur Jean Poulhès, 31400, Toulouse, France
| | - E Chantalat
- Department of General and Gynecological Surgery, University Hospital Center (CHU)-Rangueil, 1 Avenue du Professeur Jean Poulhès, 31400, Toulouse, France.
| |
Collapse
|
160
|
Chamié LP, Ribeiro DMFR, Ribeiro GMPAR, Serafini PC. Postoperative imaging findings after laparoscopic surgery for deeply infiltrating endometriosis. Abdom Radiol (NY) 2020; 45:1847-1865. [PMID: 32030450 DOI: 10.1007/s00261-020-02434-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Deeply infiltrative endometriosis (DIE) is a common gynecologic disease affecting women of reproductive age and often causing chronic pelvic pain and infertility. Clinical treatment options and preventive actions are ineffective due to the lack of knowledge about the etiology of DIE. Surgical treatment is currently the only alternative to eradicate the disease. Diagnostic imaging plays a crucial role for surgical planning and postoperative evaluation. Transvaginal sonography (TVS) with a dedicated protocol and magnetic resonance imaging (MRI) can be used to evaluate recurrent disease. Extensive pelvic surgery may cause anatomical changes and a variable spectrum of postoperative findings. Residual disease and complications can be also evaluated and are of great importance to estimate pain relief and fertility prognosis. The most common imaging findings following radical surgery for DIE are fibrotic scars in the retrocervical space and bowel anastomosis, absence of the posterior vaginal fornix and loculated fluid in the pararectal spaces. Ovaries are the most frequent site of early recurrence. Complications include infection, hemorrhage, urinary/evacuatory voiding dysfunctions as well as bowel and ureteral stenosis. The purpose of this article is to review the surgical techniques currently used to treat endometriosis in the retrocervical space, vagina, bladder, bowel, ureters, and ovaries and to describe the most common imaging findings including normal aspects, residual disease, complications, and recurrence.
Collapse
Affiliation(s)
- Luciana P Chamié
- Department of Diagnostic Imaging, Chamié Imagem da Mulher, Rua Casa do Ator, 1117, cj 72, São Paulo, São Paulo, 04546-004, Brazil.
- Department of Diagnostic Imaging, Fleury Medicina e Saúde, São Paulo, São Paulo, Brazil.
| | - Duarte M F R Ribeiro
- Department of Female Reconstructive Surgery, Clínica Doutor Duarte Miguel Ferreira Ribeiro, São Paulo, São Paulo, Brazil
| | - Gladis M P A R Ribeiro
- Department of Female Reconstructive Surgery, Clínica Doutor Duarte Miguel Ferreira Ribeiro, São Paulo, São Paulo, Brazil
| | - Paulo C Serafini
- Clínica Huntington de Medicina Reprodutiva, São Paulo, São Paulo, Brazil
- Department of Gynecology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
161
|
Hindman N, Eswar C, Huang K, Tong A. Medical management of endometriosis: what the radiologist needs to know. Abdom Radiol (NY) 2020; 45:1866-1871. [PMID: 32270260 DOI: 10.1007/s00261-020-02507-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The role of the radiologist in the diagnosis and management of patients with endometriosis is increasing. Improvement in MRI imaging techniques has improved detection rate of subtle manifestations of endometriosis by radiologists. Therefore, the role of imaging in the diagnosis and follow-up after treatment is also likely to increase. Knowledge of new medical management pathways used in treating patients with endometriosis-related pain is important. The knowledge of various medication regimens will allow radiologists to continue to evaluate baseline disease, and to potentially assess for imaging response/stability to these medications. This article will review the current medical therapies in use in the management of endometriosis-related pain and describe potential imaging-related findings expected with these therapies.
Collapse
Affiliation(s)
- Nicole Hindman
- NYU Radiology, NYU School of Medicine, 660 First Avenue, New York, NY, 10016, USA.
| | - Christopher Eswar
- NYU Obstetrics and Gynecology, NYU School of Medicine, 660 First Avenue, New York, NY, 10016, USA
| | - Kathy Huang
- NYU Obstetrics and Gynecology, NYU School of Medicine, 660 First Avenue, New York, NY, 10016, USA
| | - Angela Tong
- NYU Radiology, NYU School of Medicine, 660 First Avenue, New York, NY, 10016, USA
| |
Collapse
|
162
|
Xholli A, Filip G, Previtera F, Cagnacci A. Modification of endometrioma size during hormone therapy containing dienogest. Gynecol Endocrinol 2020; 36:545-549. [PMID: 31842632 DOI: 10.1080/09513590.2019.1703942] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The aim of the present study was to evaluate whether hormone therapy containing dienogest is effective in reducing endometrioma size. A retrospective observational study was conducted on 116 women with endometrioma which was evaluated after 6 and 12 months of either no treatment (n = 46), or hormonal therapy containing dienogest (n = 70), without (DNG; n = 34) or with ethinylestradiol (DNG/EE; n = 36). Median (interquartile range) cyst diameter (23.0 mm (21.0 mm)) and volume (9941.2 mm3 (14240.1 mm3)) of untreated were similar to cyst diameter (25.0 mm (14.5 mm) and volume (7587.7 mm3 (13806.2 mm3)) of treated women. After 12 months, endometrioma volume did not vary in untreated women (-34.0 mm3 (55595.0 mm3); -0.77% (93.9%)) while it significantly decreased (-5400 mm3 (15378.7 mm3); -100.0% (27.7%); p<.0001) during hormone therapy. Volume decrease was linearly related to endometrioma volume ([Formula: see text] R2 = 0.899, p<.0001). The effect tended to be greater during DNG alone than DNG/EE (-100.0% (0.0%) vs. -87.9% (47.7%); p<.0004). Cyst disappearance was observed in 4.4% of untreated cases and in 57.1% of cases on hormone therapy (p<.0001) (38.9% with DNG/EE and 76.5% with DNG; p<.03). The early diagnosis and treatment of endometrioma with dienogest-based hormone therapy may be effective in controlling cyst growth and in reducing the need for surgery.
Collapse
Affiliation(s)
- Anjeza Xholli
- Department of Obstetrics Gynaecology and Paediatrics, Obstetrics and Gynecology Unit, University of Udine, Udine, Italy
| | - Gabriele Filip
- Department of Obstetrics Gynaecology and Paediatrics, Obstetrics and Gynecology Unit, University of Udine, Udine, Italy
| | - Francesca Previtera
- Department of Obstetrics Gynaecology and Paediatrics, Obstetrics and Gynecology Unit, University of Udine, Udine, Italy
| | - Angelo Cagnacci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Obstetrics Gynaecology and Paediatrics, Obstetrics and Gynecology Clinic, Hospital San Martino-IRCCS, University of Genova, Genova, Italy
| |
Collapse
|
163
|
Kwok H, Jiang H, Li T, Yang H, Fei H, Cheng L, Yao S, Chen S. Lesion distribution characteristics of deep infiltrating endometriosis with ovarian endometrioma: an observational clinical study. BMC WOMENS HEALTH 2020; 20:111. [PMID: 32434535 PMCID: PMC7240912 DOI: 10.1186/s12905-020-00974-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 05/10/2020] [Indexed: 01/07/2023]
Abstract
Background To investigate the characteristics of deep infiltrating endometriosis (DIE) lesion distribution when associated with ovarian endometrioma (OEM). Methods The present study analyzed retrospective data obtained by the First Affiliated Hospital of Sun Yat-sen University, between June 2008 to June 2016. A total of 304 patients underwent laparoscopic surgery for complete removal of endometriosis by one experienced surgeon, and histological confirmation of OEM associated with DIE was conducted for each patient. Clinical data were recorded for each patient from medical, operative and pathological reports. Patients were then divided into two groups according to unilateral or bilateral OEM. Patients with unilateral OEM were subsequently divided into two subgroups according to OEM location (left- or right-hand side) and the diameter of the OEM (≤50 and > 50 mm). The distribution characteristics of DIE lesions were then compared between the groups. Results DIE lesions were widely distributed, 30 anatomical sites were involved. Patients with associated unilateral OEM (n = 184 patients) had a significantly increased number of DIE lesions when compared with patients with bilateral OEM (n = 120 patients; 2.76 ± 1.52 vs. 2.33 ± 1.34; P = 0.006). Compared with bilateral OEM with DIE, there was a higher rate of intestinal (39.1% vs. 18.3%; P < 0.01) and vaginal (17.4% vs. 6.7%; P < 0.01) infiltration by DIE lesions in unilateral OEM with DIE. The mean number of DIE lesions was not significantly correlated with the location or size of the OEM (2.83 ± 1.56 vs. 2.74 ± 1.53; P = 0.678; and 2.65 ± 1.42 vs. 2.80 ± 1.43; P = 0.518, respectively). There was no significant difference between the groups with OEM ≤50 mm and > 50 mm. Conclusion Lesion distribution characteristics in women diagnosed with histologically proven OEM associated with DIE were frequently multifocal and severe.
Collapse
Affiliation(s)
- Hungling Kwok
- Department of Obstetrics and Gynecology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Hongye Jiang
- Department of Obstetrics and Gynecology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510000, China
| | - Tian Li
- Department of Obstetrics and Gynecology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Huan Yang
- Department of Gynecology, Shenzhen Second People's Hospital/ the First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Hui Fei
- Department of Obstetrics and Gynecology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Li Cheng
- Department of Obstetrics and Gynecology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Shuzhong Yao
- Department of Obstetrics and Gynecology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510000, China
| | - Shuqin Chen
- Department of Obstetrics and Gynecology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510000, China.
| |
Collapse
|
164
|
Yang F, Liu B, Xu L, Liu H. Age at surgery and recurrence of ovarian endometrioma after conservative surgery: a meta-analysis including 3125 patients. Arch Gynecol Obstet 2020; 302:23-30. [PMID: 32430756 PMCID: PMC7266855 DOI: 10.1007/s00404-020-05586-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 05/05/2020] [Indexed: 02/03/2023]
Abstract
PURPOSE To evaluate the association between age at surgery and recurrence rate of endometrioma. Data sources PubMed, Embase, and the Cochrane Library were searched up to October 2019. METHODS We determined the pooled relative risk (RR) and 95% confidence intervals (CIs) to assess the relationship between age at surgery and the recurrence rate of endometrioma after surgery. Begg's funnel plot and Egger's linear regression was used to assess any publication bias. RESULTS A total of 3125 patients from 10 studies were finally enrolled in this meta-analysis. The recurrence rate decreased with increasing age (RR = 0.93, 95% CI = 0.91-0.95, P = 0.451). Subgroup analysis demonstrated that the pooled RR was 0.926 (95% CI 0.906-0.947, P < 0.001) for a cut-off < 35, and 0.886 (95% CI 0.775-1.040, P = 0.14) for a cut-off ≥ 35. Begg's funnel plot and Egger's linear regression test showed no evidence of publication bias. CONCLUSION This meta-analysis suggested that younger age might be a high-risk factor for the recurrence of ovarian endometrioma after conservative surgery.
Collapse
Affiliation(s)
- Fang Yang
- Department of Gynecology of Traditional Chinese Medicine, China-Japan Friendship Hospital, Ying Hua Yuan East Street, Chao Yang District, Beijing, China
| | - Baoqin Liu
- Department of Gynecology of Traditional Chinese Medicine, China-Japan Friendship Hospital, Ying Hua Yuan East Street, Chao Yang District, Beijing, China
| | - Lin Xu
- Department of Gynecology of Traditional Chinese Medicine, China-Japan Friendship Hospital, Ying Hua Yuan East Street, Chao Yang District, Beijing, China
| | - Hong Liu
- Department of Gynecology of Traditional Chinese Medicine, China-Japan Friendship Hospital, Ying Hua Yuan East Street, Chao Yang District, Beijing, China.
| |
Collapse
|
165
|
Vizzielli G, Cosentino F, Raimondo D, Turco LC, Vargiu V, Iodice R, Mastronardi M, Mabrouk M, Scambia G, Seracchioli R. Real three‐dimensional approach vs two‐dimensional camera with and without real‐time near‐infrared imaging with indocyanine green for detection of endometriosis: A case‐control study. Acta Obstet Gynecol Scand 2020; 99:1330-1338. [DOI: 10.1111/aogs.13866] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 03/25/2020] [Accepted: 03/31/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Giuseppe Vizzielli
- Department of Women’s and Children’s Health and Public Health Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS Rome Italy
| | | | - Diego Raimondo
- Department of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences S. Orsola HospitalUniversity of Bologna Bologna Italy
| | - Luigi C. Turco
- Division of Gynecologic Oncology Gemelli Molise Campobasso Italy
| | | | - Raffaella Iodice
- Department of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences S. Orsola HospitalUniversity of Bologna Bologna Italy
| | - Manuela Mastronardi
- Department of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences S. Orsola HospitalUniversity of Bologna Bologna Italy
| | - Mohamed Mabrouk
- Department of Obstetrics and Gynecology Faculty of Medicine University of Cambridge Cambridge UK
| | - Giovanni Scambia
- Department of Women’s and Children’s Health and Public Health Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS Rome Italy
- Università Cattolica del Sacro Cuore Rome Italy
| | - Renato Seracchioli
- Department of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences S. Orsola HospitalUniversity of Bologna Bologna Italy
| |
Collapse
|
166
|
Zakhari A, Edwards D, Ryu M, Matelski JJ, Bougie O, Murji A. Dienogest and the Risk of Endometriosis Recurrence Following Surgery: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2020; 27:1503-1510. [PMID: 32428571 DOI: 10.1016/j.jmig.2020.05.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/05/2020] [Accepted: 05/10/2020] [Indexed: 02/06/2023]
Abstract
STUDY OBJECTIVE To determine whether dienogest therapy after endometriosis surgery reduces the risk of endometriosis recurrence compared with expectant management. DATA SOURCES Ovid MEDLINE, Ovid EMBASE, PubMed, Cochrane Central Register of Controlled Trials, Web of Science, LILACS, clinicaltrials.gov, and International Standard Randomized Controlled Trial Number Registry were searched from inception to March 2019 for observational and randomized controlled trials. METHODS OF STUDY SELECTION The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Medical Subject Heading terms and keywords such as "dienogest," "endometriosis," and "recurrence" were used to identify relevant studies. TABULATION, INTEGRATION, AND RESULTS The search yielded 328 studies, 10 of which were eligible for inclusion, representing 1184 patients treated with dienogest and 846 expectantly managed controls. Among these studies, 9 looked exclusively at endometrioma recurrence, whereas 1 used reappearance of symptoms as evidence of disease recurrence. Data on both incidence of and time to recurrence of endometriosis were extracted. The incidence rate of endometriosis recurrence in patients treated with dienogest was 2 per 100 women over a mean follow-up of 29 months (95% confidence interval [CI], 1.43-3.11) versus 29 per 100 women managed expectantly over a mean follow-up of 36 months (95% CI, 25.66-31.74). The likelihood of recurrence was significantly reduced with postoperative dienogest (log odds -1.96, CI, -2.53 to -1.38, p <.001). CONCLUSION Patients receiving dienogest after conservative surgery for endometriosis had significantly lower risk of postoperative disease recurrence than those who were expectantly managed.
Collapse
Affiliation(s)
- Andrew Zakhari
- Department of Obstetrics and Gynecology, McGill University Health Center, Montreal, QC, Canada (Drs. Zakhari, Edwards, and Murji)
| | - Darl Edwards
- Department of Obstetrics and Gynecology, McGill University Health Center, Montreal, QC, Canada (Drs. Zakhari, Edwards, and Murji)
| | - Michelle Ryu
- Department of Mount Sinai Hospital, Sidney Liswood Health Sciences Library, Toronto, ON, Canada (Ms. Ryu)
| | - John J Matelski
- Mount Sinai Hospital, University of Toronto, Toronto, Biostatistics Research Unit, University Health Network, Toronto, Canada (Mr. Matelski)
| | - Olga Bougie
- Department of Obstetrics and Gynecology, Queen's University, Kingston General Hospital, Kingston (Dr. Bougie), Ontario, Canada
| | - Ally Murji
- Department of Obstetrics and Gynecology, McGill University Health Center, Montreal, QC, Canada (Drs. Zakhari, Edwards, and Murji).
| |
Collapse
|
167
|
Yan D, Liu X, Xu H, Guo SW. Platelets induce endothelial-mesenchymal transition and subsequent fibrogenesis in endometriosis. Reprod Biomed Online 2020; 41:500-517. [PMID: 32709523 DOI: 10.1016/j.rbmo.2020.03.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 03/07/2020] [Accepted: 03/13/2020] [Indexed: 02/06/2023]
Abstract
RESEARCH QUESTION Do endometriotic lesions undergo endothelial-mesenchymal transition (EndoMT)? DESIGN Lesion samples from 30 patients with ovarian endometriomas and deep endometriosis, and control endometrial tissue samples from 30 women without endometriosis, were analysed. In-vitro experimentation using the human umbilical vein endothelial cell (HUVEC) line were conducted. Immunofluorescence staining and immunohistochemistry analysis using antibodies against endothelial cell and mesenchymal cell markers were conducted. The HUVEC cells were co-cultured with activated platelets or control medium with and without neutralization of TGF-β1 PDGFR, or both. Their morphology, proliferation and expression levels of genes and proteins known to be involved in EndoMT were evaluated, along with their migratory and invasive propensity, contractility and collagen production capability. RESULTS The proportion of CD31 and FSP-1 dual-positive cells in FSP-1+ fibroblasts was 74.7% (±5.4%) in ovarian endometrioma lesions, significantly higher than that in deep endometriosis lesions (26.8% ± 26.0%; P = 5.7 × 10-5), and was zero in normal endometrium. The extent of lesional fibrosis correlated positively with staining levels of the lesional mesenchymal markers FSP-1 and α-SMA (r = 0.91; P < 2.2 × 10-16, r = 0.81; P = 5.8 × 10-15, respectively). Human endothelial cells co-cultured with activated platelets acquire a morphology suggestive of EndoMT, concomitant with increased proliferation, loss of CD31 but marked increase in expression of mesenchymal markers. Morphological and gene and protein expression changes are accompanied by functional differentiation reflected by increased migratory and invasive capacity, contractility and collagen production. Neutralization of TGF-β1 and PDGFR signalling abolished platelet-induced EndoMT in human endothelial cells. CONCLUSIONS Multiple sources of myofibroblasts exist in endometriotic lesions, and implicates platelets, EndoMT, or both, as potential therapeutic targets for treating endometriosis.
Collapse
Affiliation(s)
- Dingmin Yan
- Shanghai Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China
| | - Xishi Liu
- Shanghai Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China; Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Fudan University, Shanghai, China
| | - Hong Xu
- Department of Obstetrics and Gynecology, Shanghai Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 100045, China
| | - Sun-Wei Guo
- Shanghai Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China; Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Fudan University, Shanghai, China.
| |
Collapse
|
168
|
Madanes D, Bilotas MA, Bastón JI, Singla JJ, Meresman GF, Barañao RI, Ricci AG. PI3K/AKT pathway is altered in the endometriosis patient's endometrium and presents differences according to severity stage. Gynecol Endocrinol 2020; 36:436-440. [PMID: 31637941 DOI: 10.1080/09513590.2019.1680627] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Based on the inflammatory nature and hormone-dependency of endometriosis, PI3K/AKT signaling appears to influence its progression. Could the endometriosis stages be linked to differential changes in PI3K/AKT pathway regulation? The objective is to evaluate the expression of PI3K, PTEN, AKT and p-AKT in endometrial human biopsies, according to the presence or absence of the disease, and to assess the underlying differences regarding the endometriosis stages. Biopsy specimens of the ectopic and eutopic endometrium were obtained from twenty women with untreated peritoneal endometriosis as well as endometrium biopsies from nine controls. Our study revealed an increased expression of PI3K in eutopic and ectopic endometrium from patients with endometriosis, and a reduced expression of PTEN and increased levels of AKT phosphorylation, compared to control endometrium. Both eutopic and ectopic endometrium from patients with minimal-mild endometriosis expressed a significant reduced PTEN level compared to the respective endometrium from patients with moderate-severe endometriosis. The ratio p-AKT/total AKT showed higher levels of AKT phosphorylation in endometriotic tissue from patients with minimal-mild endometriosis. This study has firmly confirmed the alteration in PI3K/AKT pathway regulation and demonstrated clear differences between the stages of endometriosis, emphasizing the importance of this pathway in the first stage of the disease.
Collapse
Affiliation(s)
- Daniela Madanes
- Laboratorio de Inmunología de la Reproducción, Instituto de Biología y Medicina Experimental - Consejo Nacional de Investigaciones Científicas y Técnicas (IBYME-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| | - Mariela A Bilotas
- Laboratorio de Inmunología de la Reproducción, Instituto de Biología y Medicina Experimental - Consejo Nacional de Investigaciones Científicas y Técnicas (IBYME-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| | - Juan I Bastón
- Laboratorio de Fisiopatología Endometrial, Instituto de Biología y Medicina Experimental - Consejo Nacional de Investigaciones Científicas y Técnicas (IBYME-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| | - José J Singla
- Hospital de Clínicas José de San Martín, Ciudad Autónoma de Buenos Aires, Argentina
| | - Gabriela F Meresman
- Laboratorio de Fisiopatología Endometrial, Instituto de Biología y Medicina Experimental - Consejo Nacional de Investigaciones Científicas y Técnicas (IBYME-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| | - Rosa I Barañao
- Laboratorio de Inmunología de la Reproducción, Instituto de Biología y Medicina Experimental - Consejo Nacional de Investigaciones Científicas y Técnicas (IBYME-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| | - Analía G Ricci
- Laboratorio de Inmunología de la Reproducción, Instituto de Biología y Medicina Experimental - Consejo Nacional de Investigaciones Científicas y Técnicas (IBYME-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| |
Collapse
|
169
|
Abstract
Endometriosis is a disease of reproductive age women that is commonly characterized by symptoms that often negatively impact quality of life. The clinical management of endometriosis remains highly variable and mostly influenced by geographic location, practice patterns, and breadth of clinician experience. This variability in treatment has inspired a trend towards multidisciplinary and specialized care of patients suffering from this disease. Surgical sampling, followed by histologic confirmation of endometrial-like tissue, remains the standard for the definitive diagnosis of endometriosis. However, the high sensitivity and specificity of MRI and ultrasound has shed light on the path towards non-surgical diagnosis of deep infiltrating endometriosis. Molecular variability and intricacy of this disease has limited the development of biologic markers to target for non-invasive diagnosis and pharmacologic therapies. Surgical management of advanced-stage endometriosis can be difficult, mostly secondary to the invasive nature of the disease, and anatomical distortion requiring advanced surgical skills to manage. The high prevalence of chronic pelvic pain and other complex pain syndromes in patients with endometriosis also requires knowledge in the management of these types of issues in order to provide comprehensive care. Menopausal endometriosis, extrapelvic presentation, and potential malignant transformation of lesions are infrequent, requiring a high index of suspicion for timely diagnosis and treatment.
Collapse
Affiliation(s)
- Miguel A Luna Russo
- Section of Benign Gynecology, Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA -
| | - Julia N Chalif
- Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | |
Collapse
|
170
|
Moses AS, Taratula OR, Lee H, Luo F, Grenz T, Korzun T, Lorenz AS, Sabei FY, Bracha S, Alani AWG, Slayden OD, Taratula O. Nanoparticle-Based Platform for Activatable Fluorescence Imaging and Photothermal Ablation of Endometriosis. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2020; 16:e1906936. [PMID: 32250034 PMCID: PMC7210057 DOI: 10.1002/smll.201906936] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 05/06/2023]
Abstract
Endometriosis is a painful disorder where endometrium-like tissue forms lesions outside of the uterine cavity. Intraoperative identification and removal of these lesions are difficult. This study presents a nanoplatform that concurrently delineates and ablates endometriosis tissues using real-time near-infrared (NIR) fluorescence and photothermal therapy (PTT). The nanoplatform consists of a dye, silicon naphthalocyanine (SiNc), capable of both NIR fluorescence imaging and PTT, and a polymeric nanoparticle as a SiNc carrier to endometriosis tissue following systemic administration. To achieve high contrast during fluorescence imaging of endometriotic lesions, nanoparticles are constructed to be non-fluorescent prior to internalization by endometriosis cells. In vitro studies confirm that these nanoparticles activate the fluorescence signal following internalization in macaque endometrial stromal cells and ablate them by increasing cellular temperature to 53 ° C upon interaction with NIR light. To demonstrate in vivo efficiency of the nanoparticles, biopsies of endometrium and endometriosis from rhesus macaques are transplanted into immunodeficient mice. Imaging with the intraoperative Fluobeam 800 system reveals that 24 h following intravenous injection, nanoparticles efficiently accumulate in, and demarcate, endometriotic grafts with fluorescence. Finally, the nanoparticles increase the temperature of endometriotic grafts up to 47 °C upon exposure to NIR light, completely eradicating them after a single treatment.
Collapse
Affiliation(s)
- Abraham S Moses
- College of Pharmacy, Oregon State University, 2730 SW Moody Avenue, Portland, OR, 97201, USA
| | - Olena R Taratula
- College of Pharmacy, Oregon State University, 2730 SW Moody Avenue, Portland, OR, 97201, USA
| | - Hyelim Lee
- College of Pharmacy, Oregon State University, 2730 SW Moody Avenue, Portland, OR, 97201, USA
| | - Fangzhou Luo
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, 505 NW 185th Avenue, Beaverton, OR, 97006, USA
| | - Tanner Grenz
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, 505 NW 185th Avenue, Beaverton, OR, 97006, USA
| | - Tetiana Korzun
- College of Pharmacy, Oregon State University, 2730 SW Moody Avenue, Portland, OR, 97201, USA
| | - Anna St Lorenz
- College of Pharmacy, Oregon State University, 2730 SW Moody Avenue, Portland, OR, 97201, USA
| | - Fahad Y Sabei
- College of Pharmacy, Oregon State University, 2730 SW Moody Avenue, Portland, OR, 97201, USA
| | - Shay Bracha
- Carlson College of Veterinary Medicine, Oregon State University, 700 SW 30th Street, Corvallis, OR, 97331, USA
| | - Adam W G Alani
- College of Pharmacy, Oregon State University, 2730 SW Moody Avenue, Portland, OR, 97201, USA
| | - Ov D Slayden
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, 505 NW 185th Avenue, Beaverton, OR, 97006, USA
| | - Oleh Taratula
- College of Pharmacy, Oregon State University, 2730 SW Moody Avenue, Portland, OR, 97201, USA
| |
Collapse
|
171
|
Murji A, Biberoğlu K, Leng J, Mueller MD, Römer T, Vignali M, Yarmolinskaya M. Use of dienogest in endometriosis: a narrative literature review and expert commentary. Curr Med Res Opin 2020; 36:895-907. [PMID: 32175777 DOI: 10.1080/03007995.2020.1744120] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objective: Endometriosis affects up to 10% of women of reproductive age, and the main goal of treatment is to relieve symptoms. Progestins have been the mainstay of endometriosis suppression, of which dienogest has become an important option in many parts of the world. This is an expert literature review, with recommendations on the use of dienogest in the context of various clinical considerations when treating endometriosis.Methods: A search of PubMed was conducted for papers published between 2007 and 2019 on the use of dienogest in endometriosis. Experts reviewed these and included those they considered most relevant in clinical practice, according to their own clinical experience.Results: Evidence regarding the long-term use (>15 months) of dienogest for the management of endometriosis is presented, with experts concluding that the efficacy of dienogest should be assessed primarily on its impact on pain and quality of life. Fertility preservation, the option to avoid or delay surgery, and managing bleeding irregularities that can occur with this treatment are also considered. Counseling women on potential bleeding risks before starting treatment may be helpful, and evidence suggests that few women discontinue treatment for this reason, with the benefits of treatment outweighing any impact of bleeding irregularities.Conclusions: Overall, the evidence demonstrates that dienogest offers an effective and tolerable alternative or adjunct to surgery and provides many advantages over combined hormonal contraceptives for the treatment of endometriosis. It is important that treatment guidelines are followed and care is tailored to the woman's individual needs and desires.
Collapse
Affiliation(s)
- Ally Murji
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | | | - Jinhua Leng
- Peking Union Medical College Hospital, Beijing, China
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Thomas Römer
- Department of Obstetrics and Gynecology, Academic Hospital of Obstetrics and Gynecology, University of Cologne, Cologne, Germany
| | - Michele Vignali
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Maria Yarmolinskaya
- Department of Gynecological Endocrinology, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, Saint Petersburg, Russia
| |
Collapse
|
172
|
Chantalat E, Valera MC, Vaysse C, Noirrit E, Rusidze M, Weyl A, Vergriete K, Buscail E, Lluel P, Fontaine C, Arnal JF, Lenfant F. Estrogen Receptors and Endometriosis. Int J Mol Sci 2020; 21:ijms21082815. [PMID: 32316608 PMCID: PMC7215544 DOI: 10.3390/ijms21082815] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/10/2020] [Accepted: 04/15/2020] [Indexed: 12/17/2022] Open
Abstract
Endometriosis is a frequent and chronic inflammatory disease with impacts on reproduction, health and quality of life. This disorder is highly estrogen-dependent and the purpose of hormonal treatments is to decrease the endogenous ovarian production of estrogens. High estrogen production is a consistently observed endocrine feature of endometriosis. mRNA and protein levels of estrogen receptors (ER) are different between a normal healthy endometrium and ectopic/eutopic endometrial lesions: endometriotic stromal cells express extraordinarily higher ERβ and significantly lower ERα levels compared with endometrial stromal cells. Aberrant epigenetic regulation such as DNA methylation in endometriotic cells is associated with the pathogenesis and development of endometriosis. Although there is a large body of data regarding ERs in endometriosis, our understanding of the roles of ERα and ERβ in the pathogenesis of endometriosis remains incomplete. The goal of this review is to provide an overview of the links between endometriosis, ERs and the recent advances of treatment strategies based on ERs modulation. We will also attempt to summarize the current understanding of the molecular and cellular mechanisms of action of ERs and how this could pave the way to new therapeutic strategies.
Collapse
Affiliation(s)
- Elodie Chantalat
- IUCT Oncopole, 31100 Toulouse, France
- INSERM-UPS UMR U1048, Institut des Maladies Métaboliques et Cardiovasculaires, Université de Toulouse, BP 84225, CEDEX 04, 31 432 Toulouse, France
| | - Marie-Cécile Valera
- INSERM-UPS UMR U1048, Institut des Maladies Métaboliques et Cardiovasculaires, Université de Toulouse, BP 84225, CEDEX 04, 31 432 Toulouse, France
- Correspondence:
| | | | - Emmanuelle Noirrit
- INSERM-UPS UMR U1048, Institut des Maladies Métaboliques et Cardiovasculaires, Université de Toulouse, BP 84225, CEDEX 04, 31 432 Toulouse, France
| | - Mariam Rusidze
- INSERM-UPS UMR U1048, Institut des Maladies Métaboliques et Cardiovasculaires, Université de Toulouse, BP 84225, CEDEX 04, 31 432 Toulouse, France
| | | | | | - Etienne Buscail
- Department of Visceral Surgery, CHU Rangueil, 31400 Toulouse, France
| | | | - Coralie Fontaine
- INSERM-UPS UMR U1048, Institut des Maladies Métaboliques et Cardiovasculaires, Université de Toulouse, BP 84225, CEDEX 04, 31 432 Toulouse, France
| | - Jean-François Arnal
- INSERM-UPS UMR U1048, Institut des Maladies Métaboliques et Cardiovasculaires, Université de Toulouse, BP 84225, CEDEX 04, 31 432 Toulouse, France
| | - Françoise Lenfant
- INSERM-UPS UMR U1048, Institut des Maladies Métaboliques et Cardiovasculaires, Université de Toulouse, BP 84225, CEDEX 04, 31 432 Toulouse, France
| |
Collapse
|
173
|
Alhayo S, Leonardi M, Lu C, Gosal P, Reid S, Barto W, Condous G. Ultrasound evaluation of pouch of Douglas obliteration and rectal deep endometriosis in women who have had previous combined colorectal and gynaecological laparoscopic surgery for rectal endometriosis: A pilot study. Aust N Z J Obstet Gynaecol 2020; 60:258-263. [DOI: 10.1111/ajo.13112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 12/01/2019] [Indexed: 01/13/2023]
Affiliation(s)
- Sam Alhayo
- Colorectal Surgery Unit Department of General Surgery Nepean Hospital Sydney NSW Australia
| | - Mathew Leonardi
- Acute Gynaecology Early Pregnancy and Advanced Endoscopic Surgery Unit Nepean Hospital Sydney NSW Australia
- Sydney Medical School Nepean University of Sydney Sydney NSW Australia
| | - Chuan Lu
- Department of Computer Sciences University of Aberystwyth Wales UK
| | - Preet Gosal
- Colorectal Surgery Unit Department of General Surgery Nepean Hospital Sydney NSW Australia
| | - Shannon Reid
- Department of Obstetrics and Gynaecology Liverpool Hospital Liverpool NSW Australia
| | - Walid Barto
- Colorectal Surgery Unit Department of General Surgery Nepean Hospital Sydney NSW Australia
| | - George Condous
- Acute Gynaecology Early Pregnancy and Advanced Endoscopic Surgery Unit Nepean Hospital Sydney NSW Australia
- Sydney Medical School Nepean University of Sydney Sydney NSW Australia
- LaSGeG (Laparoscopic Surgery for General Gynaecologists) Sydney NSW Australia
| |
Collapse
|
174
|
Park W, Park MY, Song G, Lim W. 5,7‐Dimethoxyflavone induces apoptotic cell death in human endometriosis cell lines by activating the endoplasmic reticulum stress pathway. Phytother Res 2020; 34:2275-2286. [DOI: 10.1002/ptr.6677] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 03/03/2020] [Accepted: 03/06/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Wonhyoung Park
- Department of Biotechnology Korea University Seoul Republic of Korea
| | - Min Young Park
- Department of Biotechnology Korea University Seoul Republic of Korea
| | - Gwonhwa Song
- Department of Biotechnology Korea University Seoul Republic of Korea
| | - Whasun Lim
- Department of Food and Nutrition Kookmin University Seoul Republic of Korea
| |
Collapse
|
175
|
Schwartz K, Llarena NC, Rehmer JM, Richards EG, Falcone T. The role of pharmacotherapy in the treatment of endometriosis across the lifespan. Expert Opin Pharmacother 2020; 21:893-903. [PMID: 32164462 DOI: 10.1080/14656566.2020.1738386] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Endometriosis is estimated to affect 10% of reproductive-aged women. The gold standard for treatment is surgery; however, surgery carries a significant morbidity and cost burden. There is an ongoing need for safe, effective medical therapies for endometriosis patients, both in conjunction with and independent of surgical interventions. Most conventional therapies for endometriosis work by a similar mechanism, and efficacy is variable. In recent years, there has been increased interest in the development and testing of novel pharmacotherapies for endometriosis. AREAS COVERED This review discusses both conventional and emerging treatments for endometriosis. The authors present the application of these drugs in different presentations of endometriosis across the lifespan and discuss how emerging therapies might fit into future medical management of endometriosis. Conventional therapies include nonsteroidal anti-inflammatory drugs, combined oral contraceptives, progestins, GnRH agonists/antagonists, and aromatase inhibitors. Emerging therapies are focused on disease-specific targets such as endothelial growth factor receptors. EXPERT OPINION The field of endometriosis therapy is moving toward modifying the immune and inflammatory milieu surrounding endometrial implants. If these drugs show efficacy in clinical trials, combining them with current medical treatment is expected to result in a profound impact on symptom and disease burden for patients who suffer from endometriosis worldwide.
Collapse
Affiliation(s)
- Kaia Schwartz
- Women's Health Institute, Cleveland Clinic Foundation , Cleveland, OH, United States
| | - Natalia C Llarena
- Women's Health Institute, Cleveland Clinic Foundation , Cleveland, OH, United States
| | - Jenna M Rehmer
- Women's Health Institute, Cleveland Clinic Foundation , Cleveland, OH, United States
| | - Elliott G Richards
- Women's Health Institute, Cleveland Clinic Foundation , Cleveland, OH, United States
| | - Tommaso Falcone
- Women's Health Institute, Division of Reproductive Endocrinology and Infertility, Cleveland Clinic Foundation , Cleveland, OH, United States
| |
Collapse
|
176
|
Margatho D, Carvalho NM, Bahamondes L. Endometriosis-associated pain scores and biomarkers in users of the etonogestrel-releasing subdermal implant or the 52-mg levonorgestrel-releasing intrauterine system for up to 24 months. EUR J CONTRACEP REPR 2020; 25:133-140. [PMID: 32069126 DOI: 10.1080/13625187.2020.1725461] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: The aims of the study were to correlate endometriosis-associated pain, evaluated by visual analogue scale (VAS) scores, with serum levels of etonogestrel (ENG), levonorgestrel (LNG), CA-125 and soluble CD23 in users of the ENG implant or the 52-mg LNG-releasing intrauterine system (52 mg LNG-IUS) for up to 2 years after device placement.Methods: A randomised trial was conducted at the University of Campinas Medical School, Brazil. All participants (n = 103) had had endometriosis-associated chronic pelvic pain or dysmenorrhoea, or both, for more than 6 months. Participants were randomly assigned to use an ENG implant (experimental treatment) or a 52-mg LNG-IUS (active comparator). Follow-up was conducted 6 monthly for up to 24 months after device placement. Dysmenorrhoea and chronic pelvic pain were evaluated using a VAS and the scores were correlated with serum levels of ENG, LNG, CA-125 and soluble CD23.Results: Both progestin-only contraceptives significantly reduced VAS scores for dysmenorrhoea and chronic pelvic pain and reduced serum levels of soluble CD23 (p < 0.001). Serum levels of CA-125 decreased only in the ENG implant group after 24 months' use of the device (p < 0.001). No correlation was found between pain scores and ENG or LNG serum levels over time (p > 0.005).Conclusion: Both contraceptives improved dysmenorrhoea and chronic pelvic pain scores in women with endometriosis-associated pain and they reduced serum levels of soluble CD23; however, serum levels of CA-125 were reduced only in ENG implant users over the 24-month study period.
Collapse
Affiliation(s)
- Deborah Margatho
- Department of Obstetrics and Gynaecology, University of Campinas Medical School, Campinas, São Paulo, Brazil
| | - Nelsilene Mota Carvalho
- Department of Obstetrics and Gynaecology, University of Campinas Medical School, Campinas, São Paulo, Brazil
| | - Luis Bahamondes
- Department of Obstetrics and Gynaecology, University of Campinas Medical School, Campinas, São Paulo, Brazil
| |
Collapse
|
177
|
Cho B, Roh JW, Park J, Jeong K, Kim TH, Kim YS, Kwon YS, Cho CH, Park SH, Kim SH. Safety and Effectiveness of Dienogest (Visanne®) for Treatment of Endometriosis: A Large Prospective Cohort Study. Reprod Sci 2020; 27:905-915. [PMID: 32052358 DOI: 10.1007/s43032-019-00094-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 07/23/2019] [Indexed: 12/20/2022]
Abstract
Dienogest (DNG) is a progestin with highly selective progesterone activity and known to be effective in the treatment of endometriosis. This prospective cohort study in patients who had been treated with DNG 2 mg (Visanne®) for endometriosis was conducted to assess the safety and effectiveness of DNG in a large Korean cohort. This study included 3356 patients with endometriosis from 73 centers in Korea. All patients were treated with DNG 2 mg daily and were followed up for at least 6 months after initial visit. Any adverse events were recorded including severity, onset/closing date, outcomes, treatments, and the causality with DNG. Effectiveness of DNG was measured by changes in visual analogue scale (VAS) from baseline at the end of follow-up. The mean age of the subjects was 34.96 years, and the mean duration of treatment was 285.44 days. Incidence of adverse drug reaction (ADR) was 13.27% (413/3113). The most frequently reported ADR were "abnormal uterine bleeding" 4.14% (129/3113), "increased weight" 2.57% (80/3113), and "headache" 1.22% (38/3113). The number of patients (%) with favorable bleeding patterns was observed to increase as the duration of treatment increases. Amenorrhea was observed in 29.63%, 41.25%, 46.26%, and 53.20% of patients at 3 months, 6 months, 12 months, and more than 12 months follow-up period, respectively. The mean (±SD) VAS change from baseline at the last follow-up visit was -28.19 ± 28.39 mm (P value < 0.0001). This large cohort study confirms, in routine clinical practice, that DNG is safe and effective for treatment of endometriosis.
Collapse
Affiliation(s)
- BaikSeol Cho
- Medical Affairs Women's Healthcare, Bayer Korea Ltd. Pharmaceutical, Seoul, Republic of Korea
| | - Ju-Won Roh
- Department of Obstetrics and Gynecology, Dongguk University Ilsan Hospital, Gyeonggi-do, Republic of Korea
| | - Jonghoon Park
- Department of Obstetrics and Gynecology, Ilsin Christian Hospital, Busan, Republic of Korea.,Department of Obstetrics and Gynecology, Bonseng Memorial Hospital, Busan, Republic of Korea
| | - Kyungah Jeong
- Department of Obstetrics and Gynecology, College of Medicine, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Tae-Hee Kim
- Department of Obstetrics and Gynecology, Soonchunhyang University Bucheon Hospital, Gyeonggi-do, Republic of Korea
| | - Yun Sook Kim
- Soonchunhyang University College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Yong-Soon Kwon
- Department of Obstetrics and Gynecology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Republic of Korea.,Department of Obstetrics and Gynecology, Eulji University, Nowon Eulji Medical Center, Seoul, Republic of Korea
| | - Chi-Heum Cho
- Obstetrics and Gynecology, School of Medicine, Keimyung University, Daegu, Republic of Korea
| | - Sung Ho Park
- Department of Obstetrics and Gynecology, Kangnam Sacred Heart Hospital, Hallym University, Seoul, Republic of Korea
| | - Sung Hoon Kim
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
178
|
Recurrence Patterns after Surgery in Patients with Different Endometriosis Subtypes: A Long-Term Hospital-Based Cohort Study. J Clin Med 2020; 9:jcm9020496. [PMID: 32054117 PMCID: PMC7073694 DOI: 10.3390/jcm9020496] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 02/03/2020] [Accepted: 02/06/2020] [Indexed: 12/14/2022] Open
Abstract
Recurrence of endometriosis after surgery constitutes a serious challenge. Whether there is an evolution of lesion subtypes with each recurrence and whether certain lesions subtypes tend to recur faster than others is not adequately addressed. Medical records of all patients who underwent surgery for endometriosis between 1997 and 2018 in the Department of Gynecology and Obstetrics, University of Bern, were reviewed. Inclusion criteria was surgically confirmed endometriosis recurrence, defined as a subsequent surgery for endometriosis after a previous complete surgical excision of endometriosis lesions. Three subtypes of endometriosis were defined: superficial peritoneal endometriosis (SUP), ovarian endometrioma (OMA), and deep infiltrating endometriosis (DIE). Time to recurrence and variation in endometriosis subtype between the first and recurrent surgeries were the primary outcome measures. Out of the 322 patients with recurrent surgery that were identified, for 234 of them, the endometriosis subtype at first surgery was confirmed and classified (SUP = 56, OMA = 124, DIE = 54). No statistically significant difference was found for time to recurrence between lesion subtypes. SUP compared to the other groups had a higher possibility of presenting with SUP at recurrence (Odds Ratio (OR): 3.65, 95% confidence interval (CI): 1.74–7.51) and OMA compared to the other groups had a higher possibility of presenting with OMA at recurrence (OR: 3.72, 95% CI: 2.04–6.74). Nevertheless, a large number of SUP patients subsequently presented with OMA (10/56: 17.9%) or DIE (27/56: 48.2%) lesions at recurrence. Similarly, a large number of OMA patients subsequently presented with DIE (49/124: 39.5%) lesions at recurrence. In conclusion, although SUP and OMA patients compared to the others are more likely to present with the same subtype at recurrence, increasing lesion subtype severity occurs in a substantial proportion of patients. Time to recurrence is independent from the lesion subtype at first surgery.
Collapse
|
179
|
Kim SJ, Kim SK, Lee JR, Suh CS, Kim SH. Oocyte cryopreservation for fertility preservation in women with ovarian endometriosis. Reprod Biomed Online 2020; 40:827-834. [PMID: 32295746 DOI: 10.1016/j.rbmo.2020.01.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/20/2020] [Accepted: 01/28/2020] [Indexed: 01/25/2023]
Abstract
RESEARCH-QUESTION What is the clinical usefulness of oocyte cryopreservation for fertility preservation in women with ovarian endometriosis? DESIGN Clinical characteristics were retrospectively analysed in 34 women with endometrioma before a planned ovarian cystectomy. Ovarian stimulation outcomes were compared according to laterality. A one-to-one propensity score-matched analysis was conducted to compare ovarian stimulation outcomes of the first cycle in patients with endometrioma undergoing fertility preservation with those in infertile patients without endometrioma who underwent IVF treatment. The number of oocytes cryopreserved in repeated ovarian stimulation cycles was analysed. RESULTS The mean endometrioma size at diagnosis was 6.0 ± 2.5 cm. The mean age, serum anti-Mullerian hormone levels and number of oocytes cryopreserved were 30.7 ± 5.9 years, 1.85 ± 1.14 ng/ml, and 4.8 ± 3.2, respectively. The number of oocytes cryopreserved in bilateral endometrioma compared with unilateral endometrioma patients was 4.1 ± 2.9 versus 5.7 ± 3.4 (P = 0.600). In the propensity score-matched cohort (n = 22 per group), the number of oocytes retrieved was significantly lower in the patients with endometrioma undergoing fertility preservation compared with that in infertile patients without endometrioma (5.4 ± 3.8 versus 8.1 ± 4.8; P = 0.045). A total of 13 (38.2%) patients with endometrioma underwent repeated stimulation. The median (interquartile range) number of cryopreserved oocytes at the first and the second cycle were 3.0 (2.5-6.0) and 5.0 (2.5-7.5), respectively. CONCLUSIONS Women with endometrioma should be counselled about oocyte cryopreservation for fertility preservation before surgery. The number of cryopreserved oocytes can be increased by repeated oocyte retrieval.
Collapse
Affiliation(s)
- Se Jeong Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 82 Gumiro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, Korea 13620; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul Korea 03080; Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University School of Medicine, Seoul Korea 06125
| | - Seul Ki Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 82 Gumiro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, Korea 13620; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul Korea 03080
| | - Jung Ryeol Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 82 Gumiro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, Korea 13620; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul Korea 03080.
| | - Chang Suk Suh
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul Korea 03080
| | - Seok Hyun Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul Korea 03080
| |
Collapse
|
180
|
Ball E, Khan KS. Recent advances in understanding and managing chronic pelvic pain in women with special consideration to endometriosis. F1000Res 2020; 9:F1000 Faculty Rev-83. [PMID: 32089831 PMCID: PMC7001750 DOI: 10.12688/f1000research.20750.1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2020] [Indexed: 12/26/2022] Open
Abstract
Chronic pelvic pain (CPP) in women is defined variably, but for clinical use it is cyclical or non-cyclical pain of at least 3-6 months' duration. It has major impacts on individuals and society. There are both structural and idiopathic causes. Whereas CPP is not curable in many cases, it is treatable. The most promising approach is multidisciplinary patient-centered care including cause-directed therapy, lifestyle changes, talking therapies, meditation, acupuncture, and physiotherapy (this is not a complete list). One of the most common structural causes for CPP is endometriosis. This review investigates current scientific concepts and recent innovations in this field as well as for CPP in general.
Collapse
Affiliation(s)
- Elizabeth Ball
- Department of Obstetrics and Gynaecology, The Royal London Hospital, Barts Health NHS Trust, London, UK
- Women’s Health Research Unit, Yvonne Carter Building, Queen Mary University of London, London, UK
- Centre for Maternal & Child Health Research, School of Health Sciences, City University of London, London, UK
| | - Khalid S Khan
- Department of Public Health, University of Granada, Granada, Spain
| |
Collapse
|
181
|
Pécout M, Jean Dit Gautier E, Doucède G, Collinet P, Rubod C. Pelvic endometriosis: Refer to the surgeon at the right moment: Pelvic endometriosis: When refer to the surgeon? J Gynecol Obstet Hum Reprod 2020; 49:101701. [PMID: 32028037 DOI: 10.1016/j.jogoh.2020.101701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 01/16/2020] [Accepted: 01/24/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND As endometriosis is not a single condition but different morphological types, it is easy to conceive that its management allow for a diversity of approaches. The objective of this literature review is about a simplified pathway through care for patients with endometriosis, and to target the right time for surgical treatment. METHODS Through a literature and references review, the different surgical care arrangements according to attainment, to symptoms and to the patients demands and expectations are reviewed. RESULTS An existing literature and recommendations synthesis has been done, and it was found that an optimum medical or surgical care rely on a multidisciplinary approach. Asymptomatic patients should not have surgery, and the medical treatment precede surgical treatment in numerous indications. In case of a surgical need, the right moment is determined by the recommendations, as noted in this article. Different aspects are necessary, the symptomatology, the intend to be pregnant and the recurrence of lesions in particular, but also the use of medically assisted reproduction or not. CONCLUSION In order to optimize the surgical treatment of patients with endometriosis, it is advisable to not refer these patients to the surgeon not too soon and not too late, furthermore if he's an expert. In all cases the treatment is multidisciplinary, and the most difficult cases are referred to multidisciplinary consultative reunion. The surgical treatment relies on "centre of expertise's" existence for some specific forms of deep endometriosis. The surgical treatment is a question of both pathology and timing. BRIEF SUMMARY In order to optimize the surgical treatment of endometriosis, it is advisable to refer patients to the surgeon at the right moment.
Collapse
Affiliation(s)
- Marie Pécout
- Gynaecology Surgery Department, CHU Lille, F-59000, Lille, France.
| | - Estelle Jean Dit Gautier
- Gynaecology Surgery Department, CHU Lille, F-59000, Lille, France; Lille University, Faculty of Medicine, F-59000, Lille, France.
| | - Guillaume Doucède
- Gynaecology Surgery Department, CHU Lille, F-59000, Lille, France; Lille University, Faculty of Medicine, F-59000, Lille, France.
| | - Pierre Collinet
- Gynaecology Surgery Department, CHU Lille, F-59000, Lille, France; Lille University, Faculty of Medicine, F-59000, Lille, France.
| | - Chrystèle Rubod
- Gynaecology Surgery Department, CHU Lille, F-59000, Lille, France; Lille University, Faculty of Medicine, F-59000, Lille, France.
| |
Collapse
|
182
|
Bendifallah S, Vesale E, Daraï E, Thomassin-Naggara I, Bazot M, Tuech JJ, Abo C, Roman H. Recurrence after Surgery for Colorectal Endometriosis: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2020; 27:441-451.e2. [DOI: 10.1016/j.jmig.2019.09.791] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/17/2019] [Accepted: 09/23/2019] [Indexed: 01/27/2023]
|
183
|
Siegenthaler F, Knabben L, Mohr S, Nirgianakis K, Imboden S, Mueller MD. Visualization of endometriosis with laparoscopy and near-infrared optics with indocyanine green. Acta Obstet Gynecol Scand 2020; 99:591-597. [PMID: 31943126 DOI: 10.1111/aogs.13803] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/16/2019] [Accepted: 12/31/2019] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Endometriosis is a common health problem, affecting 10% of women of reproductive age. Laparoscopic surgery is proven to relieve pain and to improve fertility in women with endometriosis. However, identifying peritoneal endometriosis lesions may be difficult due to their polymorphic aspects. Endometriosis lesions harbor a high degree of neovascularization. The visualization of tissue perfusion by the additional use of near infrared fluorescence imaging with indocyanine green (ICG) may improve the detection of endometriosis lesions. MATERIAL AND METHODS In a single-center, prospective, single-arm pilot study, patients undergoing laparoscopic surgery for suspected endometriosis and/or infertility were recruited. All patients first had white light imaging with systematical documentation of all suspicious areas. ICG was then administered intravenously at .3 mg/kg bodyweight and the near infrared imaging was activated and an identical documentation of suspected lesions was performed again. After removal, the specimen were sent to pathology. CLINICAL TRIAL REGISTRATION clinicaltrials.gov NCT03850158. RESULTS In total, 173 suspected lesions were identified and excised, of which 150 had histologically proven endometriosis. Of the total number, 166 suspected lesions were detected using white-light and 32 with ICG. Among the 32 suspected lesions found with ICG, 22 were confirmed to be endometriosis. Seven additional lesions were identified with ICG alone, of which only one was histologically proven endometriosis. Positive predictive values were 89.8%, 68.8% and 86.7% for white-light laparoscopy alone, near-infrared (NIR)-ICG visualization alone, and the combination of white-light and NIR-ICG, respectively. ICG exposure time, previous abdominal surgery and rARSM stage showed a statistically significant impact on the ICG detection rate. In seven patients, ICG was used for the resection of deep infiltrating nodules from the rectum. In these cases, NIR fluorescence imaging with ICG was useful to define the borders between an endometriotic nodule and healthy tissue. CONCLUSIONS The diagnostic value of NIR-ICG imaging in identifying endometriosis appears to be minimal. ICG exposure time over 20 minutes, no previous abdominal surgery and low rASRM stages have a significant positive effect on the ICG detection rate. NIR fluorescence imaging with ICG was helpful in the resection of deep infiltrating nodules in providing a better visualization of endometriosis.
Collapse
Affiliation(s)
- Franziska Siegenthaler
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Laura Knabben
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Stefan Mohr
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Konstantinos Nirgianakis
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Sara Imboden
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| |
Collapse
|
184
|
Abokhrais IM, Denison FC, Whitaker LHR, Saunders PTK, Doust A, Williams LJ, Horne AW. A two-arm parallel double-blind randomised controlled pilot trial of the efficacy of Omega-3 polyunsaturated fatty acids for the treatment of women with endometriosis-associated pain (PurFECT1). PLoS One 2020; 15:e0227695. [PMID: 31951599 PMCID: PMC6968860 DOI: 10.1371/journal.pone.0227695] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 12/22/2019] [Indexed: 12/17/2022] Open
Abstract
Background Endometriosis is defined by the presence of endometrial-like tissue (lesions) outside the uterus, commonly on the pelvic peritoneum. It affects 6–10% of women and is associated with debilitating pelvic pain. Current management options are often unsatisfactory. Omega-3 polyunsaturated fatty acids (O-PUFA) have the potential to reduce the painful symptoms associated with endometriosis, reduce lesion size, preserve the patient’s ability to conceive, and have minimal side effects. We performed a two-arm, parallel double-blinded randomised controlled trial to inform the planning of a future multicentre randomised controlled trial to evaluate the efficacy of O-PUFA for endometriosis-associated pain. Objectives The primary objectives of the trial were to assess recruitment and retention rates. The secondary objectives were to determine the acceptability to women of the proposed methods of recruitment, randomisation, treatments and questionnaires, to estimate the variability in the proposed primary endpoints to inform the sample size calculation and to refine the research methodology for the future definitive trial. Methods We recruited women with endometriosis from June 2016 to June 2017 and randomised them to eight weeks of treatment with O-PUFA or olive oil. Pain scores and quality of life questionnaires were collected at baseline and eight weeks. We calculated the proportion of eligible women randomised, and of randomised participants who were followed up to eight weeks. Acceptability questionnaires were used to evaluate women’s experiences of the trial. Results The proportion of eligible participants who were randomised was 45.2% (33/73) and 81.8% (27/33) completed the study. The majority of participants described their overall trial experience favourably and there were no adverse events in either group. Conclusion Our pilot trial supports the feasibility of a future larger trial to definitively evaluate the efficacy of O-PUFA for endometriosis-associated pain. Trial registration The trial was registered on the ISRCTN registry (registration number ISRCTN44202346).
Collapse
Affiliation(s)
- Ibtisam M. Abokhrais
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
| | - Fiona C. Denison
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
| | - Lucy H. R. Whitaker
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Ann Doust
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Andrew W. Horne
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
- * E-mail:
| |
Collapse
|
185
|
Altayyeb A, Othman E, Khashbah M, Esmaeel A, El-Mokhtar M, Lambalk C, Mijatovic V, Abdelgawad M. Characterization of Mechanical Signature of Eutopic Endometrial Stromal Cells of Endometriosis Patients. Reprod Sci 2020; 27:364-374. [PMID: 32046462 DOI: 10.1007/s43032-019-00042-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 04/10/2019] [Indexed: 11/29/2022]
Abstract
Endometriosis affects 5-10% of women in reproductive age and causes pelvic pain and subfertility. Exact etiology of the disease is unknown. Here, we present a microfluidic platform for characterizing mechanical properties of eutopic endometrial stromal cells of endometriosis patients based on cellular deformability inside narrow microchannels. Primary human endometrial stromal cells were isolated from eutopic endometrium of endometriosis patients (4407 cells, from 7 endometriosis patients) and from disease-free women (4541 cells, from 6 control women) and were pumped through microchannels (formed of polydimethylsiloxane (PDMS) by standard soft lithography, with dimensions of 8 × 20 × 150 μm, as width × height × length) at a constant flow rate of 2 μL/min. High-speed imaging was used to capture videos of cells as they flow inside microchannels, and a computer vision code was used to track cells, measure their area, and calculate the time each cell takes to pass through the microchannel. Compared with their counterparts from control women, eutopic endometrial stromal cells from endometriosis patients showed significantly increased deformation index (1.65 ± 0.2 versus 1.43 ± 0.19, respectively, P value < 0.001), and higher velocity in travelling through narrow microchannels (96.530 ± 0.710 mm/s versus 57.518 ± 0.585 mm/s, respectively, P value < 0.001). The same difference in velocities between the two cell types was maintained after controlling for cell area. Eutopic endometrial stromal cells of endometriosis patients showed a mechanical phenotype characterized by high deformability and reduced stiffness. This mechanical signature can represent basis of a mechanical biomarker of endometriosis.
Collapse
Affiliation(s)
- Ahmad Altayyeb
- Center for Nanotechnology, Zewail City of Science and Technology, Giza, Egypt
| | - Essam Othman
- Department of Obstetrics and Gynecology, Assiut University, Assiut, Egypt. .,Amsterdam University Medical Center, Location VUmc, Academic Endometriosis Center, Amsterdam, The Netherlands.
| | - Maha Khashbah
- Department of Obstetrics and Gynecology, Assiut University, Assiut, Egypt
| | | | - Mohamed El-Mokhtar
- Department of Medical Microbiology and Immunology, Assiut University, Assiut, Egypt
| | - Cornelis Lambalk
- Amsterdam University Medical Center, Location VUmc, Academic Endometriosis Center, Amsterdam, The Netherlands
| | - Velja Mijatovic
- Amsterdam University Medical Center, Location VUmc, Academic Endometriosis Center, Amsterdam, The Netherlands
| | - Mohamed Abdelgawad
- Mechanical Engineering department, Assiut University, Assiut, Egypt. .,Mechanical Engineering Department, American University of Sharjah, Sharjah, UAE.
| |
Collapse
|
186
|
Tanshinone IIA contributes to the pathogenesis of endometriosis via renin angiotensin system by regulating the dorsal root ganglion axon sprouting. Life Sci 2020; 240:117085. [DOI: 10.1016/j.lfs.2019.117085] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 11/15/2019] [Accepted: 11/15/2019] [Indexed: 12/27/2022]
|
187
|
Molecular profile of eutopic and ectopic endometrium in endometriosis. GINECOLOGIA.RO 2020. [DOI: 10.26416/gine.28.2.2020.3179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
|
188
|
Mc Cormack BA, Bilotas MA, Madanes D, Ricci AG, Singla JJ, Barañao RI. Potential use of ellagic acid for endometriosis treatment: its effect on a human endometrial cell cycle, adhesion and migration. Food Funct 2020; 11:4605-4614. [DOI: 10.1039/d0fo00267d] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
EA treatment decreases cell adhesion and migration of endometrial cells and alters the progression of an endometrial stromal cell line cycle.
Collapse
Affiliation(s)
- B. A. Mc Cormack
- Laboratorio de Inmunología de la Reproducción
- Instituto de Biología y Medicina Experimental
- (IBYME-CONICET)
- Buenos Aires C1428ADN
- Argentina
| | - M. A. Bilotas
- Laboratorio de Inmunología de la Reproducción
- Instituto de Biología y Medicina Experimental
- (IBYME-CONICET)
- Buenos Aires C1428ADN
- Argentina
| | - D. Madanes
- Laboratorio de Inmunología de la Reproducción
- Instituto de Biología y Medicina Experimental
- (IBYME-CONICET)
- Buenos Aires C1428ADN
- Argentina
| | - A. G. Ricci
- Laboratorio de Inmunología de la Reproducción
- Instituto de Biología y Medicina Experimental
- (IBYME-CONICET)
- Buenos Aires C1428ADN
- Argentina
| | - J. J. Singla
- Hospital de Clínicas “José de San Martín”
- Buenos Aires C1120AAR
- Argentina
| | - R. I. Barañao
- Laboratorio de Inmunología de la Reproducción
- Instituto de Biología y Medicina Experimental
- (IBYME-CONICET)
- Buenos Aires C1428ADN
- Argentina
| |
Collapse
|
189
|
Toullec L, Batteux F, Santulli P, Chouzenoux S, Jeljeli M, Belmondo T, Hue S, Chapron C. High Levels of Anti-GM-CSF Antibodies in Deep Infiltrating Endometriosis. Reprod Sci 2020; 27:211-217. [PMID: 32046390 DOI: 10.1007/s43032-019-00021-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 03/25/2019] [Indexed: 12/19/2022]
Abstract
Endometriosis is a chronic hormono-dependent inflammatory gynecological disease. Endometriosis can be subdivided into three forms: superficial peritoneal implants, endometrioma, and deep infiltrating endometriosis (DIE). Inflammation is a typical feature of endometriosis with overproduction of prostaglandins, chemokines, and cytokines, like granulocyte-macrophage colony-stimulating factor (GM-CSF). GM-CSF is a hematopoietic growth factor and immune modulator which belongs to the group of cytokines that actively participate in inflammatory reactions. GM-CSF autoantibodies (Ab) are described in inflammatory diseases such as Crohn disease and ulcerative colitis where high concentrations of anti-GM-CSF Ab are correlated with severity, complications, and relapses. We have evaluated the presence of anti-GM-CSF Ab in the serum of 106 patients with endometriosis and 92 controls using a home-made enzyme-linked immunosorbent assay (ELISA) and correlated the results with the form and severity of the disease. We found that anti-GM-CSF Ab level is significantly increased in the sera of patients with endometriosis compared to controls and is associated with the severity of the disease especially in patients with deep endometriosis (p < 0.0001) with the highest number of lesions (p = 0.0034), including digestive involvement (p = 0.0041). We also found a correlation between these levels of anti-GM-CSF Ab and the number of lesions in DIE patients (r = 0.913). In this way, searching anti-GM-CSF Ab in endometriosis patient sera could be of value for patient follow-up and put further insight into the role of inflammation and of GM-CSF in endometriosis pathogenesis.
Collapse
Affiliation(s)
- Laurie Toullec
- Department of Immunology, Cochin University Hospital, APHP, Paris, France.,Department of Immuno-hematology, Henri Mondor University Hospital, APHP, Créteil, France
| | - Frédéric Batteux
- Department of Immunology, Cochin University Hospital, APHP, Paris, France. .,INSERM U1016, Institut Cochin, Paris, France.
| | - Pietro Santulli
- Department of Gynecology Obstetrics II and Reproductive Medicine, Cochin University Hospital, Paris, France.,INSERM U1016, Institut Cochin, Paris, France
| | | | - Mohamed Jeljeli
- Department of Immunology, Cochin University Hospital, APHP, Paris, France.,INSERM U1016, Institut Cochin, Paris, France
| | - Thibaut Belmondo
- Department of Immuno-hematology, Henri Mondor University Hospital, APHP, Créteil, France
| | - Sophie Hue
- Department of Immuno-hematology, Henri Mondor University Hospital, APHP, Créteil, France.
| | - Charles Chapron
- Department of Gynecology Obstetrics II and Reproductive Medicine, Cochin University Hospital, Paris, France. .,INSERM U1016, Institut Cochin, Paris, France.
| |
Collapse
|
190
|
Abstract
Endometriosis is one of the most common benign gynecological diseases in women of reproductive age worldwide. In past decades, a number of in-vitro models have been used to investigate the pathology and therapeutic methods for the treatment of endometriosis. The current review summarized the majority of currently available in-vitro models, which utilize a variety of cell or tissues types, including endometriotic cell lines, primary endometrial stromal cells, endometrial stem cells, endometrial explants, peritoneal explants and immune cells. These cells or tissues are cultured individually, co-cultured in 2D or 3D systems with various matrices or cultured in chicken chorioallantotic membranes and amniotic membranes culture systems. These models are able to represent one or more aspects of the process of endometriosis. These models are helpful and can be used to investigate the development of endometriosis and the underlying mechanisms of this disorder in detail, and help investigators select appropriate models for their experiments. Recently, the new concept of endometriosis as a fibrotic condition will lead research to investigate the differentiation of myofibroblasts and the development of fibrosis in endometriotic lesions, which will increase the development of novel models that can be used to investigate endometriotic fibrosis.
Collapse
Affiliation(s)
- Hongjie Fan
- The Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, P.R. China
| |
Collapse
|
191
|
Abstract
Endometriosis is a chronic pain condition affecting ∼176 million women worldwide. It is defined by the presence of endometrium-like tissue (lesions) outside the uterus, most commonly on the pelvic peritoneum. There is no cure for endometriosis. All endometriosis drug approvals to date have been contraceptive, limiting their use in women of child-bearing age. We have shown that human peritoneal mesothelial cells (HPMCs) recovered from the pelvic peritoneum of women with endometriosis exhibit significantly higher glycolysis, lower mitochondrial respiration, decreased enzymatic activity of pyruvate dehydrogenase (PDH), and increased production of lactate compared to HPMCs from women without disease. Transforming growth factor-β1 (TGF-β1) is elevated in the peritoneal fluid from women with endometriosis, and exposure of HPMCs to TGF-β1 exacerbates this abnormal phenotype. Treatment of endometriosis HPMCs with the pyruvate dehydrogenase kinase (PDK) inhibitor/PDH activator dichloroacetate (DCA) normalizes HPMC metabolism, reduces lactate secretion, and abrogates endometrial stromal cell proliferation in a coculture model. Oral DCA reduced peritoneal fluid lactate concentrations and endometriosis lesion size in a mouse model. These findings provide the rationale for targeting metabolic processes as a noncontraceptive treatment for women with endometriosis either as a primary nonhormonal treatment or to prevent recurrence after surgery.
Collapse
|
192
|
Mahajan V, Farquhar C, Ponnampalam AP. Could DNA hydroxymethylation be crucial in influencing steroid hormone signaling in endometrial biology and endometriosis? Mol Reprod Dev 2019; 87:7-16. [PMID: 31749216 DOI: 10.1002/mrd.23299] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 10/30/2019] [Indexed: 12/17/2022]
Abstract
Endometriosis affects 10% of reproductive-aged women. It is characterized by the growth of the endometrium, outside the uterus and is associated with infertility and chronic abdominal pain. Lack of noninvasive diagnostic tools and early screening tests results in delayed treatment and subsequently increased disease severity. Endometriosis is a disease associated with a deregulated hormonal response, therefore, understanding the molecular mechanisms that govern this hormonal interplay is of paramount importance. DNA methylation is an epigenetic mark that regulates gene expression and is often associated with genes that code for steroid receptors and enzymes associated with estrogen synthesis and metabolism in endometriosis. DNA hydroxymethylation, which is structurally similar to methylation but functionally different, is a biologically critical mechanism that is also known to regulate gene expression. Ten Eleven Translocation (TET) proteins mediate hydroxymethylation. However, the role of DNA hydroxymethylation or TETs in the endometrium remains relatively unexplored. Currently, the "gold standard" technique used to study methylation patterns is bisulfite genomic sequencing. This technique also detects hydroxymethylation but fails to distinguish between the two, thereby limiting our understanding of these two processes. The presence of TETs in the male and female reproductive tract and its contribution to endometrial cancer makes it an important factor to study in endometriosis. This review summarizes the role of DNA methylation in aberrant steroid hormone signaling and hypothesizes that hydroxymethylation could be a factor influencing hormonal instability seen in endometriosis.
Collapse
Affiliation(s)
- Vishakha Mahajan
- The Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Cynthia Farquhar
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Anna P Ponnampalam
- The Liggins Institute, The University of Auckland, Auckland, New Zealand.,Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.,Department of Physiology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| |
Collapse
|
193
|
Tanaka K, Mayne L, Khalil A, Baartz D, Eriksson L, Mortlock SA, Montgomery G, McKinnon B, Amoako AA. The role of the endocannabinoid system in aetiopathogenesis of endometriosis: A potential therapeutic target. Eur J Obstet Gynecol Reprod Biol 2019; 244:87-94. [PMID: 31785471 DOI: 10.1016/j.ejogrb.2019.11.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/08/2019] [Accepted: 11/13/2019] [Indexed: 01/16/2023]
Abstract
Endometriosis affects a large proportion of women during their reproductive years and is associated with pain and infertility, also affecting psychological wellbeing and quality of life. The pathogenesis of the disease remains unclear, although it is believed to be multifactorial. The endocannabinoid system (ECS) consists of a number of ligands, receptors and enzymes, and has gained interests in endometriosis research. This review aims to summarise all available evidence reporting the roles of the ECS in endometriosis. A literature search of the PubMed, EMBASE, and Web of Science electronic medical databases was performed. Original and review articles published in peer-reviewed journals were included. No publication date or publication status restrictions were imposed. Significant differences in the concentrations and expressions of the components of the ECS were reported in the eutopic and ectopic endometrium, and the systemic circulation of women with endometriosis compared to controls. Endometriosis appears to be associated with downregulation of CB1 receptors and upregulation of TRPV1 receptors. The role of CB1 and progesterone in anti-inflammatory action and the role of TRPV1 in inflammation and pain are of particular interests. Furthermore, the ECS has been reported to be involved in processes relevant to endometriosis, including cell migration, cell proliferation, apoptosis, inflammation, and interacts with sex steroid hormones. The ECS may play a role in disease establishment, progression, and pain in endometriosis. However, reports are based on studies of limited size and there are inconsistencies among the definition of their control groups. There are also conflicting reports regarding precise involvement of the ECS in endometriosis. Future research with larger numbers, strict inclusion and exclusion criteria and detailed clinical information is imperative.
Collapse
Affiliation(s)
- Keisuke Tanaka
- Department of Obstetrics and Gynaecology, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Leah Mayne
- Department of Obstetrics and Gynaecology, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Akram Khalil
- Department of Obstetrics and Gynaecology, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - David Baartz
- Department of Obstetrics and Gynaecology, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Lars Eriksson
- The University of Queensland, UQ Library, Brisbane, Queensland, Australia
| | - Sally-Anne Mortlock
- The Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia
| | - Grant Montgomery
- The Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia
| | - Brett McKinnon
- The Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia; Department of Obstetrics and Gynaecology, University Hospital of Berne, Berne, Switzerland
| | - Akwasi A Amoako
- Department of Obstetrics and Gynaecology, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
| |
Collapse
|
194
|
Vannuccini S, Reis FM, Coutinho LM, Lazzeri L, Centini G, Petraglia F. Surgical treatment of endometriosis: prognostic factors for better quality of life. Gynecol Endocrinol 2019; 35:1010-1014. [PMID: 31155975 DOI: 10.1080/09513590.2019.1616688] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The present study investigated the effect of surgical treatment of endometriosis on physical and mental health. We undertook a prospective survey including 153 premenopausal women with histological diagnosis of endometriosis. The Short Form 12 (SF-12) questionnaire comprising physical and mental component scales was used. Two groups of patients were distinguished: Group A (n = 42) with SF-12 scores above the median in both physical and mental scales; Group B (n = 111) with SF-12 scores below the median in either physical or mental scale. Group A was diagnosed and operated for endometriosis for the first time at an older age (30 vs. 26 years), had undergone more frequently a single surgical intervention (64% vs. 46%), was less affected by symptom or lesion recurrence and had reported less intense current pain symptoms than Group B. Having the first endometriosis surgery at a later age was an independent predictor of better health status (adjusted odds ratio 1.146 per year, 95% confidence interval 1.058-1.242) after accounting for the potential confounding effects of reoperation, pelvic pain and time elapsed since the first surgery. In conclusion, patients with endometriosis who had a single surgery at an older age have good symptom control and better quality of life (QoL).
Collapse
Affiliation(s)
- Silvia Vannuccini
- Department of Neuroscience, Psychology, Pharmacology and Child Health (NEUROFARBA), University of Florence, Careggi University Hospital , Florence , Italy
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecology, University Hospital of Siena , Siena , Italy
| | - Fernando M Reis
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| | - Larissa M Coutinho
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
- Department of Maternal and Child Health, Universidade Federal de Juiz de Fora , Juiz de Fora , Brazil
| | - Lucia Lazzeri
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecology, University Hospital of Siena , Siena , Italy
| | - Gabriele Centini
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecology, University Hospital of Siena , Siena , Italy
| | - Felice Petraglia
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital , Florence , Italy
| |
Collapse
|
195
|
Miura M, Ushida T, Imai K, Wang J, Moriyama Y, Nakano-Kobayashi T, Osuka S, Kikkawa F, Kotani T. Adverse effects of endometriosis on pregnancy: a case-control study. BMC Pregnancy Childbirth 2019; 19:373. [PMID: 31640604 PMCID: PMC6805464 DOI: 10.1186/s12884-019-2514-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 09/16/2019] [Indexed: 12/13/2022] Open
Abstract
Background Endometriosis is a common disease occurring in 1–2% of all women of reproductive age. Although there is increasing evidence on the association between endometriosis and adverse perinatal outcomes, little is known about the effect of pre-pregnancy treatments for endometriosis on subsequent perinatal outcomes. Thus, this study aimed to evaluate maternal and neonatal outcomes in pregnant women with endometriosis and to investigate whether pre-pregnancy surgical treatment would affect these outcomes. Methods This case-control study included 2769 patients who gave birth at Nagoya University Hospital located in Japan between 2010 and 2017. Maternal and neonatal outcomes were compared between the endometriosis group (n = 80) and the control group (n = 2689). The endometriosis group was further divided into two groups: patients with a history of surgical treatment such as cystectomy for ovarian endometriosis, ablation or excision of endometriotic implants, or adhesiolysis (surgical treatment group, n = 49) and those treated with only medications or without any treatment (non-surgical treatment group, n = 31). Results In the univariate analysis, placenta previa and postpartum hemorrhage were significantly increased in the endometriosis group compared to the control group (12.5% vs. 4.1%, p < 0.01 and 27.5% vs. 18.2%, p = 0.04, respectively). In the multivariate analysis, endometriosis significantly increased the odds ratio (OR) for placenta previa (adjusted OR, 3.19; 95% confidence interval [CI], 1.56–6.50, p < 0.01) but not for postpartum hemorrhage (adjusted OR, 1.14; 95% CI, 0.66–1.98, p = 0.64). Other maternal and neonatal outcomes were similar between the two groups. In patients with endometriosis, patients in the surgical treatment group were significantly associated with an increased risk of placenta previa (OR. 4.62; 95% CI, 2.11–10.10, p < 0.01); however, patients in the non-surgical treatment group were not associated with a high risk (OR, 1.63; 95% CI, 0.19–6.59, p = 0.36). Additionally, other maternal and neonatal outcomes were similar between the two groups. Conclusion Women who have had surgical treatment for their endometriosis appear to have a higher risk for placenta previa. This may be due to the more severe stage of endometriosis often found in these patients. However, clinicians should be alert to this potential increased risk and manage these patients accordingly.
Collapse
Affiliation(s)
- Mayo Miura
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Takafumi Ushida
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Kenji Imai
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Jingwen Wang
- Laboratory of Bell Research Center-Department of Obstetrics and Gynecology collaborative research, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yoshinori Moriyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Tomoko Nakano-Kobayashi
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Satoko Osuka
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.,Center for Maternal-Neonatal Care, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan
| | - Fumitaka Kikkawa
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Tomomi Kotani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan. .,Center for Maternal-Neonatal Care, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan. .,Department of Maternal and Perinatal Medicine, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan.
| |
Collapse
|
196
|
Liu Z, Liu L, Zhong Y, Cai M, Gao J, Tan C, Han X, Guo R, Han L. LncRNA H19 over-expression inhibited Th17 cell differentiation to relieve endometriosis through miR-342-3p/IER3 pathway. Cell Biosci 2019; 9:84. [PMID: 31636893 PMCID: PMC6792244 DOI: 10.1186/s13578-019-0346-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 09/25/2019] [Indexed: 11/13/2022] Open
Abstract
Objective To investigate the mechanism of LncRNA H19 in Th17 cell differentiation and endometrial stromal cells (ESCs) proliferation in endometriosis (EMS). Methods LncRNA H19, miR-342-3p and IER3 expressions were detected by qRT-PCR and western blot. The percentage of Th17 cells/CD4+ T cells was detected by flow cytometry. IL-17 level was measured by ELISA. The interaction of miR-342-3p and IER3 was confirmed by Luciferase reporter assay. Results LncRNA H19 and IER3 expressions were down-regulated in mononuclear cells from peritoneal fluid (PFMCs) of patients with EMS or under Th17 differentiation conditions, whereas miR-342-3p expression was up-regulated and the percentage of Th17 cells was increased in PFMCs of patients with EMS or under Th17 differentiation conditions. Over-expression of LncRNA H19 decreased IL-17 level and the percentage of Th17 cells/CD4+ T cells. Besides, we confirmed that miR-342-3p could target to IER3 and negatively regulate IER3 expression. LncRNA H19 over-expression suppressed Th17 differentiation and ESC proliferation through regulating miR-342-3p/IER3. In vivo experiments showed LncRNA H19 over-expression suppressed the growth of Th17 cell differentiation-induced endometriosis-like lesions. Conclusion LncRNA H19 was down-regulated in PFMC of patients with EMS or under Th17 polarizing conditions, and LncRNA H19 over-expression suppressed Th17 cell differentiation and ESCs proliferation through miR-342-3p/IER3 pathway.
Collapse
Affiliation(s)
- Zheying Liu
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe Dong Road, Zhengzhou, 450052 People's Republic of China
| | - Liya Liu
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe Dong Road, Zhengzhou, 450052 People's Republic of China
| | - Yun Zhong
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe Dong Road, Zhengzhou, 450052 People's Republic of China
| | - Mingbo Cai
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe Dong Road, Zhengzhou, 450052 People's Republic of China
| | - Junbi Gao
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe Dong Road, Zhengzhou, 450052 People's Republic of China
| | - Chaoyue Tan
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe Dong Road, Zhengzhou, 450052 People's Republic of China
| | - Xiaoxiao Han
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe Dong Road, Zhengzhou, 450052 People's Republic of China
| | - Ruixia Guo
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe Dong Road, Zhengzhou, 450052 People's Republic of China
| | - Liping Han
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe Dong Road, Zhengzhou, 450052 People's Republic of China
| |
Collapse
|
197
|
Guerra A, Daraï E, Osório F, Setúbal A, Bendifallah S, Loureiro A, Thomassin-Naggara I. Imaging of postoperative endometriosis. Diagn Interv Imaging 2019; 100:607-618. [DOI: 10.1016/j.diii.2018.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/12/2018] [Accepted: 11/12/2018] [Indexed: 12/22/2022]
|
198
|
Forster R, Sarginson A, Velichkova A, Hogg C, Dorning A, Horne AW, Saunders PTK, Greaves E. Macrophage-derived insulin-like growth factor-1 is a key neurotrophic and nerve-sensitizing factor in pain associated with endometriosis. FASEB J 2019; 33:11210-11222. [PMID: 31291762 PMCID: PMC6766660 DOI: 10.1096/fj.201900797r] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 06/17/2019] [Indexed: 12/31/2022]
Abstract
Endometriosis is a common incurable inflammatory disorder that is associated with debilitating pelvic pain in women. Macrophages are central to the pathophysiology of endometriosis: they dictate the growth and vascularization of endometriosis lesions and more recently have been shown to promote lesion innervation. The aim of this study was to determine the mechanistic role of macrophages in producing pain associated with endometriosis. Herein, we show that macrophage depletion in a mouse model of endometriosis can reverse abnormal changes in pain behavior. We identified that disease-modified macrophages exhibit increased expression of IGF-1 in an in vitro model of endometriosis-associated macrophages and confirmed expression by lesion-resident macrophages in mice and women. Concentrations of IGF-1 were elevated in peritoneal fluid from women with endometriosis and positively correlate with their pain scores. Mechanistically, we demonstrate that macrophage-derived IGF-1 promotes sprouting neurogenesis and nerve sensitization in vitro. Finally, we show that the Igf-1 receptor inhibitor linsitinib reverses the pain behavior observed in mice with endometriosis. Our data support a role for macrophage-derived IGF-1 as a key neurotrophic and sensitizing factor in endometriosis, and we propose that therapies that modify macrophage phenotype may be attractive therapeutic options for the treatment of women with endometriosis-associated pain.-Forster, R., Sarginson, A., Velichkova, A., Hogg, C., Dorning, A., Horne, A. W., Saunders, P. T. K., Greaves, E. Macrophage-derived insulin-like growth factor-1 is a key neurotrophic and nerve-sensitizing factor in pain associated with endometriosis.
Collapse
Affiliation(s)
- Rachel Forster
- Medical Research Council (MRC) Centre for Reproductive Health, The Queen’s Medical Research Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Alexandra Sarginson
- Medical Research Council (MRC) Centre for Reproductive Health, The Queen’s Medical Research Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Atanaska Velichkova
- Medical Research Council (MRC) Centre for Reproductive Health, The Queen’s Medical Research Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Chloe Hogg
- Medical Research Council (MRC) Centre for Reproductive Health, The Queen’s Medical Research Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Ashley Dorning
- Medical Research Council (MRC) Centre for Reproductive Health, The Queen’s Medical Research Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Andrew W. Horne
- Medical Research Council (MRC) Centre for Reproductive Health, The Queen’s Medical Research Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Philippa T. K. Saunders
- MRC Centre for Inflammation Research, The Queen’s Medical Research Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Erin Greaves
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| |
Collapse
|
199
|
Alborzi S, Zahiri Sorouri Z, Askari E, Poordast T, Chamanara K. The success of various endometrioma treatments in infertility: A systematic review and meta-analysis of prospective studies. Reprod Med Biol 2019; 18:312-322. [PMID: 31607791 PMCID: PMC6780037 DOI: 10.1002/rmb2.12286] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/15/2019] [Accepted: 06/05/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Endometriosis is seen in 0.5%-5% of fertile and 25%-40% of infertile women. To investigate this conflict between gynecologists that ovarian endometriomas should be removed or not before making any decision about pregnancy among infertile women, the authors decided to carry out a systematic review and meta-analysis to compare the effect of various available therapeutic methods and notice the impact of these options on women's pregnancy rate. METHODS This review is based on PRISMA recommendations with an electronic search using the following databases: PubMed, Scopus, Google scholar, etc, from 2000 to 2018, in the English language. The studies compare pregnancy rate based on four different treatment types of OMAs between infertile women: (surgery + ART, surgery + spontaneous pregnancy, aspiration ± sclerotherapy + ART, and ART alone). MAIN FINDINGS At least eight prospective studies were included, in which 553 infertile women were compared in terms of treatment methods of OMAs before trying to become pregnant. CONCLUSION Treatments are usually based on the patient's clinical condition and must be individual, with the purpose of relieving pain, improving fertility, or both. The authors do not have not any significant difference between our four groups of study; however, the success of surgical procedure compared to other methods was higher and the success of ART alone was the least.
Collapse
Affiliation(s)
- Saeed Alborzi
- Department of Obstetrics and Gynecology, School of Medicine, Laparoscopy Research CenterShiraz University of Medical SciencesShirazIran
| | - Ziba Zahiri Sorouri
- Department of Obstetrics & Gynecology, School of Medicine, Reproductive Health Research Center, Alzahra HospitalGuilan University of Medical SciencesRashtIran
| | - Elham Askari
- Department of Obstetrics and Gynecology, School of Medicine, Laparoscopy Research CenterShiraz University of Medical SciencesShirazIran
| | - Tahereh Poordast
- Department of Gynecology and ObstetricsShiraz University of Medical SciencesShirazIran
| | - Kefayat Chamanara
- Department of Obstetrics and Gynecology, School of Medicine, Laparoscopy Research CenterShiraz University of Medical SciencesShirazIran
| |
Collapse
|
200
|
Ceccaroni M, Bounous VE, Clarizia R, Mautone D, Mabrouk M. Recurrent endometriosis: a battle against an unknown enemy. EUR J CONTRACEP REPR 2019; 24:464-474. [PMID: 31550940 DOI: 10.1080/13625187.2019.1662391] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Recurrence of endometriosis after conservative surgery is not an uncommon finding. There is no uniformity, however, on what the term 'recurrence' means. Recurrence is variously defined in the literature as the relapse of pain, clinical or instrumental detection of an endometriotic lesion, repeat rise in CA 125 levels, or evidence of recurrence found during repeat surgery. Consequently, the reported recurrence rate varies widely (0-89%) in the different series, depending on its definition and the type of study performed. As endometriosis recurrence seems to be an indeterminate enemy, we set out to examine exactly what we were fighting in our everyday battle. In this narrative review, we aimed to seek an answer to questions related to endometriosis recurrence, some of which are often asked by our patients.
Collapse
Affiliation(s)
- Marcello Ceccaroni
- Department of Obstetrics and Gynaecology, Gynaecological Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar, Verona, Italy
| | - Valentina Elisabetta Bounous
- Department of Surgical Sciences, Unit of Gynaecology and Obstetrics, Mauriziano Umberto I Hospital, University of Turin, Turin, Italy
| | - Roberto Clarizia
- Department of Obstetrics and Gynaecology, Gynaecological Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar, Verona, Italy
| | - Daniele Mautone
- Department of Obstetrics and Gynaecology, Gynaecological Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar, Verona, Italy
| | - Mohamed Mabrouk
- Minimally Invasive Pelvic Surgery Unit, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| |
Collapse
|