151
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Ahn SH, Monsanto SP, Miller C, Singh SS, Thomas R, Tayade C. Pathophysiology and Immune Dysfunction in Endometriosis. BIOMED RESEARCH INTERNATIONAL 2015; 2015:795976. [PMID: 26247027 PMCID: PMC4515278 DOI: 10.1155/2015/795976] [Citation(s) in RCA: 204] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 11/18/2014] [Indexed: 12/30/2022]
Abstract
Endometriosis is an estrogen-dependent, chronic, proinflammatory disease prevalent in 10% of women of reproductive age worldwide. Characterized by the growth of endometrium-like tissue in aberrant locations outside of the uterus, it is responsible for symptoms including chronic pelvic pain, dysmenorrhea, and subfertility that degrade quality of life of women significantly. In Canada, direct and indirect economic cost of endometriosis amounts to 1.8 billion dollars, and this is elevated to 20 billion dollars in the United States. Despite decades of research, the etiology and pathophysiology of endometriosis still remain to be elucidated. This review aims to bring together the current understanding regarding the pathogenesis of endometriosis with specific focus on mechanisms behind vascularization of the lesions and the contribution of immune factors in facilitating lesion establishment and development. The role of hormones, immune cells, and cytokine signaling is highlighted, in addition to discussing the current pharmaceutical options available for management of pain symptoms in women with endometriosis.
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Affiliation(s)
- Soo Hyun Ahn
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada K7L 3N6
| | - Stephany P. Monsanto
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada K7L 3N6
| | - Caragh Miller
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada K7L 3N6
| | - Sukhbir S. Singh
- Department of Obstetrics and Gynecology, University of Ottawa, The Ottawa Hospital, ON, Canada K1H 7W9
| | - Richard Thomas
- Department of Obstetrics and Gynecology, Kingston General Hospital, Kingston, ON, Canada K7L 3N6
| | - Chandrakant Tayade
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada K7L 3N6
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152
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Tosti C, Pinzauti S, Santulli P, Chapron C, Petraglia F. Pathogenetic Mechanisms of Deep Infiltrating Endometriosis. Reprod Sci 2015; 22:1053-9. [PMID: 26169038 DOI: 10.1177/1933719115592713] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Endometriosis is a benign gynecologic disease, affecting women of reproductive age associated with chronic pelvic pain, dysmenorrhea, dyspareunia and infertility. Ovarian endometrioma (OMA), superficial peritoneal endometriosis (SPE), and deep infiltrating endometriosis (DIE) are, till now, recognized as major phenotypes. The discussion is to know whether they share the same pathogenetic mechanisms. Till today, DIE is recognized as the most severe clinical form of endometriosis and has a complex clinical management. The DIE lesions have been considered in the present article, without distinguishing between the anterior (bladder) or the posterior (vagina, uterosacral ligaments, rectum, and ureter) compartment. The present knowledge indicates that hormonal function (estrogen and progesterone receptors) and immunological factors, such as peritoneal macrophages, natural killer cells, and lymphocytes, are critically altered in DIE. The aggressive behavior of DIE may be explained by the highly decreased apoptosis (nuclear factor kappa-light-chain-enhancer of activated B cells [NF-kB], B-cell lymphoma 2 [Blc-2], and anti-Mullerian hormone) and by the increased proliferation activity related to oxidative stress (NF-kB, reactive oxygen species, extracellular regulated kinase (ERK), advanced oxidation protein product). Invasive mechanisms are more expressed (matrix metalloproteinases and activins) in DIE in comparison to the OMA and SPE. Correlated with the increased invasiveness are the data on very high expression of neuroangiogenesis (nerve growth factor, vascular endothelial growth factor, and intercellular adhesion molecule) genes in DIE. Therefore, at the present time, several of the DIE pathogenetic features result specific in comparison to other endometriosis phenotypes, pleading for the existence of a specific entity. These evidence of specific pathogenetic features of DIE may explain the more severe symptomatology related to this form of endometriosis and suggest possible future target medical treatments.
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Affiliation(s)
- Claudia Tosti
- Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy Department of Gynecology Obstetrics II and Reproductive Medicine, Faculté de Médecine, AP-HP, Hôspital Cochin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Serena Pinzauti
- Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy Department of Gynecology Obstetrics II and Reproductive Medicine, Faculté de Médecine, AP-HP, Hôspital Cochin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Pietro Santulli
- Department of Gynecology Obstetrics II and Reproductive Medicine, Faculté de Médecine, AP-HP, Hôspital Cochin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France Institut Cochin, Université Paris Descartes, Sorbonne Paris Cité, CNRS (UMR 8104), Paris, France
| | - Charles Chapron
- Department of Gynecology Obstetrics II and Reproductive Medicine, Faculté de Médecine, AP-HP, Hôspital Cochin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France Institut Cochin, Université Paris Descartes, Sorbonne Paris Cité, CNRS (UMR 8104), Paris, France
| | - Felice Petraglia
- Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
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153
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Abstract
The transforming growth factor-beta (TGFβ) superfamily comprises over 30 dimeric proteins with conserved structures, which play important roles in the control of cellular proliferation, differentiation and apoptosis. These proteins are expressed and finely regulated in human endometrium during the menstrual cycle, which is consistent with their effects on endometrial cell proliferation and tissue remodeling. This review is focused on summarizing the role of key members of the TGFβ superfamily in the pathophysiology of endometriosis. Evidence suggests that TGFβ, activins, inhibins, nodal, bone morphogenetic proteins, growth differentiation factors, and anti-Müllerian hormone are produced by endometriotic lesions and could be involved in the establishment and progression of the disease. Their receptors and signaling pathways may also be altered in the presence of endometriosis and may be potential targets to the development of therapeutic agents.
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Affiliation(s)
- Cynthia Dela Cruz
- a Division of Human Reproduction, Department of Obstetrics and Gynecology , Federal University of Minas Gerais , Belo Horizonte , Brazil
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154
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Yang H, Kang K, Cheng C, Mamillapalli R, Taylor HS. Integrative Analysis Reveals Regulatory Programs in Endometriosis. Reprod Sci 2015; 22:1060-72. [PMID: 26134036 DOI: 10.1177/1933719115592709] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Endometriosis is a common gynecological disease found in approximately 10% of reproductive-age women. Gene expression analysis has been performed to explore alterations in gene expression associated with endometriosis; however, the underlying transcription factors (TFs) governing such expression changes have not been investigated in a systematic way. In this study, we propose a method to integrate gene expression with TF binding data and protein-protein interactions to construct an integrated regulatory network (IRN) for endometriosis. The IRN has shown that the most regulated gene in endometriosis is RUNX1, which is targeted by 14 of 26 TFs also involved in endometriosis. Using 2 published cohorts, GSE7305 (Hover, n = 20) and GSE7307 (Roth, n = 36) from the Gene Expression Omnibus database, we identified a network of TFs, which bind to target genes that are differentially expressed in endometriosis. Enrichment analysis based on the hypergeometric distribution allowed us to predict the TFs involved in endometriosis (n = 40). This included known TFs such as androgen receptor (AR) and critical factors in the pathology of endometriosis, estrogen receptor α, and estrogen receptor β. We also identified several new ones from which we selected FOXA2 and TFAP2C, and their regulation was confirmed by quantitative real-time polymerase chain reaction and immunohistochemistry (IHC). Further, our analysis revealed that the function of AR and p53 in endometriosis is regulated by posttranscriptional changes and not by differential gene expression. Our integrative analysis provides new insights into the regulatory programs involved in endometriosis.
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Affiliation(s)
- Huan Yang
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA Department of Gynecology, Minimally Invasive Gynecology Center, Beijing Obstetrics and Gynecology Hospital Capital Medical University, Beijing, China
| | - Kai Kang
- Department of Gynecology, Minimally Invasive Gynecology Center, Beijing Obstetrics and Gynecology Hospital Capital Medical University, Beijing, China
| | - Chao Cheng
- Department of Genetics, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Ramanaiah Mamillapalli
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Hugh S Taylor
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
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155
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CHEN YU, CAI SHENGYUN, WANG JINGWEN, XU MINGJUAN. Valproic acid-induced histone acetylation suppresses CYP19 gene expression and inhibits the growth and survival of endometrial stromal cells. Int J Mol Med 2015; 36:725-32. [DOI: 10.3892/ijmm.2015.2263] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 06/12/2015] [Indexed: 11/06/2022] Open
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156
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Simmen RCM, Heard ME, Simmen AM, Montales MTM, Marji M, Scanlon S, Pabona JMP. The Krüppel-like factors in female reproductive system pathologies. J Mol Endocrinol 2015; 54:R89-R101. [PMID: 25654975 PMCID: PMC4369192 DOI: 10.1530/jme-14-0310] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Female reproductive tract pathologies arise largely from dysregulation of estrogen and progesterone receptor signaling, leading to aberrant cell proliferation, survival, and differentiation. The signaling pathways orchestrated by these nuclear receptors are complex, require the participation of many nuclear proteins serving as key binding partners or targets, and involve a range of paracrine and autocrine regulatory circuits. The members of the Krüppel-like factor (KLF) family of transcription factors are ubiquitously expressed in reproductive tissues and have been increasingly implicated as critical co-regulators and integrators of steroid hormone actions. Herein, we explore the involvement of KLF family members in uterine pathology, describe their currently known molecular mechanisms, and discuss their potential as targets for therapeutic intervention.
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Affiliation(s)
- Rosalia C M Simmen
- Department of Physiology and BiophysicsUniversity of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USADepartment of Obstetrics and GynecologyUniversity of Michigan Health System, Ann Arbor, Michigan 48109, USADepartment of Internal MedicineHarlem Hospital Center, Columbia University Medical Center, New York, New York 10037, USA
| | - Melissa E Heard
- Department of Physiology and BiophysicsUniversity of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USADepartment of Obstetrics and GynecologyUniversity of Michigan Health System, Ann Arbor, Michigan 48109, USADepartment of Internal MedicineHarlem Hospital Center, Columbia University Medical Center, New York, New York 10037, USA
| | - Angela M Simmen
- Department of Physiology and BiophysicsUniversity of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USADepartment of Obstetrics and GynecologyUniversity of Michigan Health System, Ann Arbor, Michigan 48109, USADepartment of Internal MedicineHarlem Hospital Center, Columbia University Medical Center, New York, New York 10037, USA
| | - Maria Theresa M Montales
- Department of Physiology and BiophysicsUniversity of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USADepartment of Obstetrics and GynecologyUniversity of Michigan Health System, Ann Arbor, Michigan 48109, USADepartment of Internal MedicineHarlem Hospital Center, Columbia University Medical Center, New York, New York 10037, USA
| | - Meera Marji
- Department of Physiology and BiophysicsUniversity of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USADepartment of Obstetrics and GynecologyUniversity of Michigan Health System, Ann Arbor, Michigan 48109, USADepartment of Internal MedicineHarlem Hospital Center, Columbia University Medical Center, New York, New York 10037, USA
| | - Samantha Scanlon
- Department of Physiology and BiophysicsUniversity of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USADepartment of Obstetrics and GynecologyUniversity of Michigan Health System, Ann Arbor, Michigan 48109, USADepartment of Internal MedicineHarlem Hospital Center, Columbia University Medical Center, New York, New York 10037, USA
| | - John Mark P Pabona
- Department of Physiology and BiophysicsUniversity of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USADepartment of Obstetrics and GynecologyUniversity of Michigan Health System, Ann Arbor, Michigan 48109, USADepartment of Internal MedicineHarlem Hospital Center, Columbia University Medical Center, New York, New York 10037, USA
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157
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Grimstad FW, Carey E. Periclitoral endometriosis: the dilemma of a chronic disease invading a rare location. J Minim Invasive Gynecol 2015; 22:684-6. [PMID: 25680686 DOI: 10.1016/j.jmig.2015.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 02/03/2015] [Accepted: 02/03/2015] [Indexed: 02/06/2023]
Abstract
Endometriosis affects 6% to 10% of women of reproductive age; extrapelvic endometriosis is considered a rare event with perineal endometriosis being even rarer still (only a few cases of spontaneous episodes described, the majority being from episiotomy scars). We present a unique case of periclitoral endometriosis, which to the best of our knowledge is the first in the literature. It is a 29-year-old nulligravida female with a painful fluctuant right periclitoral mass that had been growing with no response to antibiotic therapy. At the initial removal, pathology reported the lesion as endometriosis. The patient was placed on oral contraceptives, and she was noted to have monthly swelling and shrinking of the site with her menstrual cycles. When she went off hormonal contraception, she represented with the growing lesion 3.5 weeks after her last menses; she underwent re-excision. Because of the extension of the lesion medially and its adherence to the clitoral body, the decision was made to evacuate only as much of the capsule that could be safely identified to minimize the risk of damaging the clitoris. Complete excision in this case was difficult without sacrificing a portion of the clitoris and potentially resulting in decreased sexual function and persistent clitoral pain. In a patient in whom complete excision is not possible, there is potential for mass recurrence in the setting of residual tissue. Reviewing the literature suggests that there are risks with both recurrence and clitoral excision. We found that in-depth patient counseling, hormonal suppression, and close follow-up are necessary when dealing with periclitoral endometriosis postexcision.
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Affiliation(s)
- Frances W Grimstad
- Department of Obstetrics and Gynecology, University of Kansas, Kansas City, Kansas.
| | - Erin Carey
- Department of Obstetrics and Gynecology, University of Kansas, Kansas City, Kansas
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158
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Djokovic D, Calhaz-Jorge C. Somatic stem cells and their dysfunction in endometriosis. Front Surg 2015; 1:51. [PMID: 25593975 PMCID: PMC4286966 DOI: 10.3389/fsurg.2014.00051] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 12/14/2014] [Indexed: 01/05/2023] Open
Abstract
Emerging evidence indicates that somatic stem cells (SSCs) of different types prominently contribute to endometrium-associated disorders such as endometriosis. We reviewed the pertinent studies available on PubMed, published in English language until December 2014 and focused on the involvement of SSCs in the pathogenesis of this common gynecological disease. A concise summary of the data obtained from in vitro experiments, animal models, and human tissue analyses provides insights into the SSC dysregulation in endometriotic lesions. In addition, a set of research results is presented supporting that SSC-targeting, in combination with hormonal therapy, may result in improved control of the disease, while a more in-depth characterization of endometriosis SSCs may contribute to the development of early-disease diagnostic tests with increased sensitivity and specificity. Key message: Seemingly essential for the establishment and progression of endometriotic lesions, dysregulated SSCs, and associated molecular alterations hold a promise as potential endometriosis markers and therapeutic targets.
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Affiliation(s)
- Dusan Djokovic
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa , Lisbon , Portugal ; Serviço de Obstetrícia e Ginecologia, Centro Hospitalar de Lisboa Ocidental, Hospital de São Francisco Xavier , Lisbon , Portugal
| | - Carlos Calhaz-Jorge
- Clínica Universitária de Obstetrícia e Ginecologia, Faculdade de Medicina, Universidade de Lisboa , Lisbon , Portugal ; Departamento de Obstetrícia, Ginecologia e Medicina da Reprodução, Centro Hospitalar de Lisboa Norte , Lisbon , Portugal
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159
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Identity of Human Endometrial Tissue: Potent Source of Stem Cells. Regen Med 2015. [DOI: 10.1007/978-1-4471-6542-2_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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160
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Adamyan LV, Farkhat KN, Makiyan ZN, Savilova AM. The external genital endometriosis: theories and molecular investigations (a review). ACTA ACUST UNITED AC 2015. [DOI: 10.17116/repro20152158-16] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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161
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Ono YJ, Tanabe A, Nakamura Y, Yamamoto H, Hayashi A, Tanaka T, Sasaki H, Hayashi M, Terai Y, Ohmichi M. A low-testosterone state associated with endometrioma leads to the apoptosis of granulosa cells. PLoS One 2014; 9:e115618. [PMID: 25536335 PMCID: PMC4275210 DOI: 10.1371/journal.pone.0115618] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 11/27/2014] [Indexed: 01/15/2023] Open
Abstract
Although endometriosis is suspected to be a cause of premature ovarian insufficiency (POI), the mechanism(s) underlying this process have not been elucidated. Recently, androgens were shown to promote oocyte maturation and to play a role in folliculogenesis. In addition, several reports have documented low testosterone levels in the follicular fluid obtained from endometriosis patients. We therefore examined whether the low levels of serum testosterone are associated with the apoptosis of granulosa cells in follicles obtained from endometriosis patients. Serum samples were collected from 46 patients with endometriosis and from 62 patients without endometriosis who received assisted reproductive therapy. Specimens of the ovaries obtained from 10 patients with endometrioma were collected using laparoscopy. The mean serum testosterone concentration in the patients with endometriosis was significantly lower than that observed in the patients without endometriosis. Furthermore, high expression of a pro-apoptotic Bcl-2 member, BimEL, in the follicles was found to be associated with a low serum testosterone level. We clarified the underlying mechanisms using a basic approach employing human immortalized granulosa cells derived from a primary human granulosa cell tumor, the COV434 cell line. The in vitro examination demonstrated that testosterone inhibited apoptosis induced by sex steroids depletion via the PI3K/Akt-FoxO3a pathway in the COV434 cells. In conclusion, we elucidated the mechanism underlying the anti-apoptotic effects of testosterone on granulosa cells, and found that a low-testosterone status is a potentially important step in the development of premature ovarian insufficiency in patients with endometriosis.
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Affiliation(s)
- Yoshihiro J. Ono
- Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan
| | - Akiko Tanabe
- Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan
- * E-mail:
| | - Yoko Nakamura
- Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan
| | - Hikaru Yamamoto
- Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan
| | - Atsushi Hayashi
- Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan
| | - Tomohito Tanaka
- Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan
| | - Hiroshi Sasaki
- Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan
| | - Masami Hayashi
- Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan
| | - Yoshito Terai
- Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan
| | - Masahide Ohmichi
- Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan
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162
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Matsuzaki S, Botchorishvili R, Pouly JL, Canis M. Targeting the Wnt/β-catenin pathway in endometriosis: a potentially effective approach for treatment and prevention. MOLECULAR AND CELLULAR THERAPIES 2014; 2:36. [PMID: 26056600 PMCID: PMC4451963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 11/03/2014] [Indexed: 11/21/2023]
Abstract
Endometriosis is a chronic, estrogen-dependent disease associated with infertility and pelvic pain. Endometriosis is defined by the presence of extra-uterine endometrial tissue. It affects approximately 10% of reproductive-aged women. However, the underlying etiology, pathogenesis and pathophysiology remain to be fully elucidated. Knowledge of these factors is indispensable for the development of targeted therapies for prevention and treatment of endometriosis. Several studies, including those from our laboratory, have suggested that aberrant activation of the Wnt/β-catenin pathway may be involved in the pathophysiology of endometriosis. This is a review of the literature focused on the aberrant activation of the Wnt/β-catenin pathway in patients with endometriosis, and on how targeting the Wnt/targeting pathway may be a potentially effective approach for treating and/or preventing endometriosis.
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Affiliation(s)
- Sachiko Matsuzaki
- />CHU Clermont-Ferrand, CHU Estaing, Chirurgie Gynécologique, 1, Place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand, France
- />Clermont Université, Université d’Auvergne, ISIT UMR6284, Clermont-Ferrand, France
- />CNRS, ISIT UMR6284, Clermont-Ferrand, France
| | - Revaz Botchorishvili
- />CHU Clermont-Ferrand, CHU Estaing, Chirurgie Gynécologique, 1, Place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand, France
- />Clermont Université, Université d’Auvergne, ISIT UMR6284, Clermont-Ferrand, France
- />CNRS, ISIT UMR6284, Clermont-Ferrand, France
| | - Jean Luc Pouly
- />CHU Clermont-Ferrand, CHU Estaing, Chirurgie Gynécologique, 1, Place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand, France
| | - Michel Canis
- />CHU Clermont-Ferrand, CHU Estaing, Chirurgie Gynécologique, 1, Place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand, France
- />Clermont Université, Université d’Auvergne, ISIT UMR6284, Clermont-Ferrand, France
- />CNRS, ISIT UMR6284, Clermont-Ferrand, France
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163
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Matsuzaki S, Botchorishvili R, Pouly JL, Canis M. Targeting the Wnt/β-catenin pathway in endometriosis: a potentially effective approach for treatment and prevention. MOLECULAR AND CELLULAR THERAPIES 2014; 2:36. [PMID: 26056600 PMCID: PMC4451963 DOI: 10.1186/s40591-014-0036-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 11/03/2014] [Indexed: 11/28/2022]
Abstract
Endometriosis is a chronic, estrogen-dependent disease associated with infertility and pelvic pain. Endometriosis is defined by the presence of extra-uterine endometrial tissue. It affects approximately 10% of reproductive-aged women. However, the underlying etiology, pathogenesis and pathophysiology remain to be fully elucidated. Knowledge of these factors is indispensable for the development of targeted therapies for prevention and treatment of endometriosis. Several studies, including those from our laboratory, have suggested that aberrant activation of the Wnt/β-catenin pathway may be involved in the pathophysiology of endometriosis. This is a review of the literature focused on the aberrant activation of the Wnt/β-catenin pathway in patients with endometriosis, and on how targeting the Wnt/targeting pathway may be a potentially effective approach for treating and/or preventing endometriosis.
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Affiliation(s)
- Sachiko Matsuzaki
- CHU Clermont-Ferrand, CHU Estaing, Chirurgie Gynécologique, 1, Place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand, France ; Clermont Université, Université d'Auvergne, ISIT UMR6284, Clermont-Ferrand, France ; CNRS, ISIT UMR6284, Clermont-Ferrand, France
| | - Revaz Botchorishvili
- CHU Clermont-Ferrand, CHU Estaing, Chirurgie Gynécologique, 1, Place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand, France ; Clermont Université, Université d'Auvergne, ISIT UMR6284, Clermont-Ferrand, France ; CNRS, ISIT UMR6284, Clermont-Ferrand, France
| | - Jean Luc Pouly
- CHU Clermont-Ferrand, CHU Estaing, Chirurgie Gynécologique, 1, Place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand, France
| | - Michel Canis
- CHU Clermont-Ferrand, CHU Estaing, Chirurgie Gynécologique, 1, Place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand, France ; Clermont Université, Université d'Auvergne, ISIT UMR6284, Clermont-Ferrand, France ; CNRS, ISIT UMR6284, Clermont-Ferrand, France
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164
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Yang J, Huang F. Stem cell and endometriosis: new knowledge may be producing novel therapies. Int J Clin Exp Med 2014; 7:3853-3858. [PMID: 25550893 PMCID: PMC4276151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 10/23/2014] [Indexed: 06/04/2023]
Abstract
The human endometrium is a dynamic tissue, which undergoes cycles of growth and regression with each menstrual cycle. Adult progenitor stem cells are likely responsible for this remarkable regenerative capacity; these same progenitor stem cells may also have an enhanced capacity to generate endometriosis if shed in a retrograde fashion. The progenitor stem cells reside in the uterus, and, however, may also travel from other tissues such as bone marrow to repopulate the progenitor population. Mesenchymal stem cells are also involved in the pathogenesis of endometriosis and may be the principle source of endometriosis outside of the peritoneal cavity when they differentiate into endometriosis in ectopic locations. The present short review mainly summarizes the latest observations contributing to the current knowledge regarding the presence and the potential contribution of stem cells in the etiology of endometriosis. All these data can have clinical implications and provide a basis for new potential therapeutic applications.
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Affiliation(s)
- Jing Yang
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University Changsha 410011, Hunan, China
| | - Fengying Huang
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University Changsha 410011, Hunan, China
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165
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Khan KN, Kitajima M, Hiraki K, Fujishita A, Nakashima M, Masuzaki H. Visible and occult microscopic lesions of endometriosis. Gynecol Minim Invasive Ther 2014. [DOI: 10.1016/j.gmit.2014.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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166
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Steinberg JA, Gonda DD, Muller K, Ciacci JD. Endometriosis of the conus medullaris causing cyclic radiculopathy. J Neurosurg Spine 2014; 21:799-804. [DOI: 10.3171/2014.7.spine14117] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Intramedullary spinal cord hematomas are a rare neurosurgical pathological entity typically arising from vascular and neoplastic lesions. Endometriosis is an extremely rare cause of intramedullary spinal cord hematoma, with only 5 previously reported cases in the literature. Endometriosis is characterized by ectopic endometrial tissue, typically located in the female pelvic cavity, that causes a cyclical pain syndrome, bleeding, and infertility. In the rare case of intramedullary endometriosis of the spinal cord, symptoms include cyclical lower-extremity radiculopathies and voiding difficulties, and can acutely cause cauda equina syndrome. The authors report a case of endometriosis of the conus medullaris, the first to include radiological, intraoperative, and histopathological imaging. A brief review of the literature is also presented, with discussion including etiological theories surrounding intramedullary endometriosis.
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de Almeida AM, Ramoa P, Pereira JC. Laparoscopic Resection of Adrenal Endometriosis. J Gynecol Surg 2014. [DOI: 10.1089/gyn.2013.0133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Amélia Maria de Almeida
- Department of Obstetrics and Gynecology, Centro Hospitalar Tâmega e Sousa, Penafiel, Porto, Portugal
| | - Paula Ramoa
- Department of Obstetrics and Gynecology, Hospitais Privados de Portugal, Boavista, Penafiel, Porto, Portugal
| | - Joaquim Costa Pereira
- Department of Colorectal Surgery, Centro Hospitalar Tâmega e Sousa, Penafiel, Porto, Portugal and Faculty of Medicine, Porto University, Porto, Portugal
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Juhasz-Böss I, Laschke MW, Müller F, Rosenbaum P, Baum S, Solomayer EF, Ulrich U. Endometriosis: Survey of Current Diagnostic and Therapeutic Options and Latest Research Work. Geburtshilfe Frauenheilkd 2014; 74:733-742. [PMID: 25221341 DOI: 10.1055/s-0034-1382884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 06/29/2014] [Accepted: 06/30/2014] [Indexed: 01/21/2023] Open
Abstract
Endometriosis is one of the most frequent benign diseases in women of child-bearing age. The main symptoms are chronic upper abdominal pain and infertility. However, the aetiology and pathogenesis of endometriosis are as yet insufficiently clarified. Thus, therapy is mainly symptomatic with laparoscopic surgery being the gold standard. The aim of drug therapy is to achieve a hypo-oestrogenic condition. In cases of severe endometriosis and a desire to have children there is often an indication for assisted reproduction. The present article illustrates almost all current aspects on the diagnosis of and therapy of endometriosis. From the clinical viewpoint, emphasis is placed on the rare cases of deeply infiltrating endometriosis that are, however, accompanied with a high morbidity. Current therapeutic options in cases of infertility are also presented in more detail. Furthermore, special attention is paid to the latest research results from both clinical and basic research fields in order to demonstrate our current knowledge on the pathogenesis and, where possible, potentially related therapeutic options.
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Affiliation(s)
- I Juhasz-Böss
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - M W Laschke
- Institut für Klinisch-Experimentelle Chirurgie, Universität des Saarlandes, Homburg
| | - F Müller
- Klinik für Gynäkologie und Geburtshilfe, Martin-Luther-Krankenhaus, Berlin
| | - P Rosenbaum
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - S Baum
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - E F Solomayer
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - U Ulrich
- Klinik für Gynäkologie und Geburtshilfe, Martin-Luther-Krankenhaus, Berlin
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169
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Affiliation(s)
- Tetsuo Maruyama
- Department of Obstetrics and Gynecology; School of Medicine; Keio University; Tokyo Japan
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170
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Yuan Z, Wang L, Wang Y, Zhang T, Li L, Cragun JM, Chambers SK, Kong B, Zheng W. Tubal origin of ovarian endometriosis. Mod Pathol 2014; 27:1154-62. [PMID: 24390223 DOI: 10.1038/modpathol.2013.245] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 12/05/2013] [Accepted: 12/06/2013] [Indexed: 12/20/2022]
Abstract
Endometriosis is a puzzling and debilitating disease that affects millions of women around the world. Ovary is the most common organ site involved by endometriosis. Despite various hypotheses about its cell of origin, uncertainty remains. On the basis of our clinicopathologic observations, we hypothesize that fallopian tube may contribute the histogenesis of ovarian endometriosis. To examine if the hypothesis, tubal origin of ovarian endometriosis, has scientific supporting evidence, we identified a set of novel genes, which are either highly expressed in the normal fallopian tube or in the endometrium through a gene differential array study. Among many differentially expressed genes, FMO3 and DMBT1 were selected as the initial biomarkers to test the hypothesis. These biomarkers were then validated in ovarian sections with foci of endometriosis by comparing their expression levels in the fallopian tube and the endometrium within the same patients with real-time PCR, western blot and immunohistochemistry analysis. FMO3 was highly expressed in the tubal epithelia while low in the paired endometrium. In contrast, DMBT1 was high in the endometrium but low in the fallopian tube. In 32 ovarian endometriosis cases analyzed by real-time PCR, 18 (56%) showed a high level of FMO3 and a low level of DMBT1 expression. However, 14 (44%) endometriosis cases showed a reversed expression pattern with these two markers. Results were similarly seen in the methods of western blot and immunohistochemistry. The findings suggest that approximately 60% of the ovarian endometriosis we studied may be derived from the fallopian tube, whereas about 40% of the cases may be of endometrial origin. The fallopian tube epithelia may represent one of the tissue sources contributing to ovarian endometriosis. Such novel findings, which require confirmation, may have a significant clinical impact in searching for alternative ways of prevention and treatment of endometriosis.
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Affiliation(s)
- Zeng Yuan
- 1] Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Shandong, China [2] Key Laboratory of Gynecologic Oncology, Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Shandong, China [3] Department of Pathology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Lijie Wang
- 1] Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Shandong, China [2] Key Laboratory of Gynecologic Oncology, Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Shandong, China [3] Department of Pathology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Yiying Wang
- Department of Pathology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Tingguo Zhang
- Department of Pathology, Shandong University School of Medicine, Shandong, China
| | - Li Li
- Department of Pathology, Shandong University School of Medicine, Shandong, China
| | - Janiel M Cragun
- 1] Department of Obstetrics and Gynecology, University of Arizona, Tucson, AZ, USA [2] Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
| | - Setsuko K Chambers
- 1] Department of Obstetrics and Gynecology, University of Arizona, Tucson, AZ, USA [2] Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
| | - Beihua Kong
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Shandong, China
| | - Wenxin Zheng
- 1] Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Shandong, China [2] Department of Pathology, University of Arizona College of Medicine, Tucson, AZ, USA [3] Department of Obstetrics and Gynecology, University of Arizona, Tucson, AZ, USA [4] Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
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171
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Verdi J, Tan A, Shoae-Hassani A, Seifalian AM. Endometrial stem cells in regenerative medicine. J Biol Eng 2014; 8:20. [PMID: 25097665 PMCID: PMC4121626 DOI: 10.1186/1754-1611-8-20] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 06/30/2014] [Indexed: 01/14/2023] Open
Abstract
First described in 2004, endometrial stem cells (EnSCs) are adult stem cells isolated from the endometrial tissue. EnSCs comprise of a population of epithelial stem cells, mesenchymal stem cells, and side population stem cells. When secreted in the menstrual blood, they are termed menstrual stem cells or endometrial regenerative cells. Mounting evidence suggests that EnSCs can be utilized in regenerative medicine. EnSCs can be used as immuno-modulatory agents to attenuate inflammation, are implicated in angiogenesis and vascularization during tissue regeneration, and can also be reprogrammed into induced pluripotent stem cells. Furthermore, EnSCs can be used in tissue engineering applications and there are several clinical trials currently in place to ascertain the therapeutic potential of EnSCs. This review highlights the progress made in EnSC research, describing their mesodermal, ectodermal, and endodermal potentials both in vitro and in vivo.
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Affiliation(s)
- Javad Verdi
- Centre for Nanotechnology and Regenerative Medicine, UCL Division of Surgery & Interventional Science, University College London (UCL), London NW3 2QG, UK ; Applied Cell Sciences Department, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Aaron Tan
- Centre for Nanotechnology and Regenerative Medicine, UCL Division of Surgery & Interventional Science, University College London (UCL), London NW3 2QG, UK ; UCL Medical School, University College London (UCL), London, UK
| | - Alireza Shoae-Hassani
- Applied Cell Sciences Department, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Alexander M Seifalian
- Centre for Nanotechnology and Regenerative Medicine, UCL Division of Surgery & Interventional Science, University College London (UCL), London NW3 2QG, UK ; Royal Free London NHS Foundation Trust Hospital, London, UK
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172
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Nikoo S, Ebtekar M, Jeddi-Tehrani M, Shervin A, Bozorgmehr M, Vafaei S, Kazemnejad S, Zarnani AH. Menstrual blood-derived stromal stem cells from women with and without endometriosis reveal different phenotypic and functional characteristics. Mol Hum Reprod 2014; 20:905-18. [PMID: 24939730 DOI: 10.1093/molehr/gau044] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Retrograde flow of menstrual blood cells during menstruation is considered as the dominant theory for the development of endometriosis. Moreover, current evidence suggests that endometrial-derived stem cells are key players in the pathogenesis of endometriosis. In particular, endometrial stromal stem cells have been suggested to be involved in the pathogenesis of this disease. Here, we aimed to use menstrual blood, as a novel source of endometrial stem cells, to investigate whether stromal stem cells from endometriosis (E-MenSCs) and non-endometriosis (NE-MenSCs) women differed regarding their morphology, CD marker expression pattern, proliferation, invasion and adhesion capacities and their ability to express certain immunomodulatory molecules. E-MenSCs were morphologically different from NE-MenSCs and showed higher expression of CD9, CD10 and CD29. Furthermore, E-MenSCs had higher proliferation and invasion potentials compared with NE-MenSCs. The amount of indoleamine 2,3-dioxygenase-1 (IDO1) and cyclooxygenase-2 (COX-2) in E-MenSCs co-cultured with allogenic peripheral blood mononuclear cells (PBMCs) was shown to be higher both at the gene and protein levels, and higher IDO1 activity was detected in the endometriosis group. However, NE-MenSCs revealed increased concentrations of forkhead transcription factor-3 (FOXP3) when compared with E-MenSCs. Nonetheless, interferon (IFN)-γ, Interleukin (IL)-10 and monocyte chemoattractant protein-1 (MCP-1) levels were higher in the supernatant of E-MenSCs-PBMC co-cultures. Here, we showed that there are inherent differences between E-MenSCs and NE-MenSCs. These findings propose the key role MenSCs could play in the pathogenesis of endometriosis and further support the retrograde and stem cell theories of endometriosis. Hence, considering its renewable and easily available nature, menstrual blood could be viewed as a reliable and inexpensive material for studies addressing the cellular and molecular aspects of endometriosis.
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Affiliation(s)
- Shohreh Nikoo
- Reproductive Immunology Research Center, Avicenna Research Institute, ACECR, PO Box 19615-1177, Tehran, Iran
| | - Massoumeh Ebtekar
- Department of Immunology, Faculty of Medicine, Tarbiat Modares University, PO Box 14117-13116, Tehran, Iran
| | - Mahmood Jeddi-Tehrani
- Monoclonal Antibody Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | - Adel Shervin
- Reproductive Immunology Research Center, Avicenna Research Institute, ACECR, PO Box 19615-1177, Tehran, Iran
| | - Mahmood Bozorgmehr
- Nanobiotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | - Sedigheh Vafaei
- Nanobiotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | - Somayeh Kazemnejad
- Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | - Amir-Hassan Zarnani
- Reproductive Immunology Research Center, Avicenna Research Institute, ACECR, PO Box 19615-1177, Tehran, Iran Nanobiotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran Immunology Research Center, Iran University of Medical Sciences, Tehran, Iran
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173
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Aznaurova YB, Zhumataev MB, Roberts TK, Aliper AM, Zhavoronkov AA. Molecular aspects of development and regulation of endometriosis. Reprod Biol Endocrinol 2014; 12:50. [PMID: 24927773 PMCID: PMC4067518 DOI: 10.1186/1477-7827-12-50] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Accepted: 05/29/2014] [Indexed: 12/11/2022] Open
Abstract
Endometriosis is a common and painful condition affecting women of reproductive age. While the underlying pathophysiology is still largely unknown, much advancement has been made in understanding the progression of the disease. In recent years, a great deal of research has focused on non-invasive diagnostic tools, such as biomarkers, as well as identification of potential therapeutic targets. In this article, we will review the etiology and cellular mechanisms associated with endometriosis as well as the current diagnostic tools and therapies. We will then discuss the more recent genomic and proteomic studies and how these data may guide development of novel diagnostics and therapeutics. The current diagnostic tools are invasive and current therapies primarily treat the symptoms of endometriosis. Optimally, the advancement of "-omic" data will facilitate the development of non-invasive diagnostic biomarkers as well as therapeutics that target the pathophysiology of the disease and halt, or even reverse, progression. However, the amount of data generated by these types of studies is vast and bioinformatics analysis, such as we present here, will be critical to identification of appropriate targets for further study.
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Affiliation(s)
- Yana B Aznaurova
- I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
- The First Open Institute for Regenerative Medicine for Young Scientists, Moscow, Russian Federation
- Federal Research and Clinical Center for Pediatric Hematology, Oncology and Hematology, Moscow, Russian Federation
| | - Marat B Zhumataev
- I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
- The First Open Institute for Regenerative Medicine for Young Scientists, Moscow, Russian Federation
- Federal Research and Clinical Center for Pediatric Hematology, Oncology and Hematology, Moscow, Russian Federation
| | - Tiffany K Roberts
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA
| | - Alexander M Aliper
- The First Open Institute for Regenerative Medicine for Young Scientists, Moscow, Russian Federation
- Federal Research and Clinical Center for Pediatric Hematology, Oncology and Hematology, Moscow, Russian Federation
- Moscow Institute of Physics and Technology, Moscow, Russian Federation
| | - Alex A Zhavoronkov
- I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
- The First Open Institute for Regenerative Medicine for Young Scientists, Moscow, Russian Federation
- The Biogerontology Research Foundation, London, UK
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174
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Hwang JH, Lee KS, Joo JK, Wang T, Son JB, Park JH, Hwang DY, Choi MH, Lee HG. Identification of biomarkers for endometriosis in plasma from patients with endometriosis using a proteomics approach. Mol Med Rep 2014; 10:725-30. [PMID: 24889313 DOI: 10.3892/mmr.2014.2291] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 04/04/2014] [Indexed: 11/06/2022] Open
Abstract
The present study aimed to examine potential biomarkers for the diagnosis of endometriosis. A plasma-based proteomic approach, including 2-dimentional electrophoresis and mass spectrometry, was used. Samples were obtained from patients with (n=15) and without (n=15) endometriosis, or from mice with surgically induced endometriosis. Seven spots corresponding to six differentially expressed proteins were identified in the human plasma samples. However, only haptoglobin (Hp) was identified to be significantly decreased in the plasma levels of patients with endometriosis (P<0.05) and in mice with surgically induced endometriosis (P<0.05). The results demonstrated that Hp was downregulated in females with endometriosis, and it therefore, may be a useful diagnostic tool as a biomarker of endometriosis.
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Affiliation(s)
- Jin-Hee Hwang
- Department of Animal Science and Technology, College of Animal Bioscience and Technology, Konkuk University, Seoul 143‑701, South Korea
| | - Kyu-Sup Lee
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Yangsan, Gyeongnam 626-770, South Korea
| | - Jong-Kil Joo
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Yangsan, Gyeongnam 626-770, South Korea
| | - Tao Wang
- Department of Animal Science and Technology, College of Animal Bioscience and Technology, Konkuk University, Seoul 143‑701, South Korea
| | - Jung-Bin Son
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Yangsan, Gyeongnam 626-770, South Korea
| | - Jong-Ha Park
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Yangsan, Gyeongnam 626-770, South Korea
| | - Dae-Youn Hwang
- Department of Biomaterial Science, College of Natural Resources and Life Science, Pusan National University, Miryang 627-706, South Korea
| | - Man-Ho Choi
- Future Convergence Research Division, Korea Institute of Science and Technology, Seoul 136-791, South Korea
| | - Hong-Gu Lee
- Department of Animal Science and Technology, College of Animal Bioscience and Technology, Konkuk University, Seoul 143‑701, South Korea
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175
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Song Y, Xiao L, Fu J, Huang W, Wang Q, Zhang X, Yang S. Increased expression of the pluripotency markers sex-determining region Y-box 2 and Nanog homeobox in ovarian endometriosis. Reprod Biol Endocrinol 2014; 12:42. [PMID: 24884521 PMCID: PMC4031377 DOI: 10.1186/1477-7827-12-42] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 05/03/2014] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The precise etiology of endometriosis is not fully understood; the involvement of stem cells theory is a new hypothesis. Related studies mainly focus on stemness-related genes, and pluripotency markers may play a role in the etiology of endometriosis. We aimed to analyze the transcription pluripotency factors sex-determining region Y-box 2 (SOX2), Nanog homeobox (NANOG), and octamer-binding protein 4 (OCT4) in the endometrium of reproductive-age women with and without ovarian endometriosis. METHODS We recruited 26 women with laparoscopy-diagnosed ovarian endometriosis (endometriosis group) and 16 disease-free women (control group) to the study. Endometrial and endometriotic samples were collected. SOX2, NANOG, and OCT4 expression were analyzed with quantitative real-time polymerase chain reaction, western blotting, and immunohistochemistry. RESULTS Compared to the control group, SOX2 mRNA and protein expression was significantly higher in the eutopic endometrium of participants in the endometriosis group. In the endometriosis group, SOX2 and NANOG mRNA and protein expression were significantly increased in ectopic endometrium compared with eutopic endometrium; there was a trend towards lower OCT4 mRNA expression and higher OCT4 protein expression in ectopic endometrium. CONCLUSIONS The transcription pluripotency factors SOX2 and NANOG were overexpression in ovarian endometriosis, their role in pathogenesis of endometriosis should be further studied.
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Affiliation(s)
- Yong Song
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu 610041, Sichuan, P. R. China
| | - Li Xiao
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu 610041, Sichuan, P. R. China
| | - Jing Fu
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu 610041, Sichuan, P. R. China
| | - Wei Huang
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu 610041, Sichuan, P. R. China
| | - Qiushi Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu 610041, Sichuan, P. R. China
| | - Xianghui Zhang
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu 610041, Sichuan, P. R. China
| | - Shiyuan Yang
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu 610041, Sichuan, P. R. China
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176
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Li T, He H, Liu R, Wang SX, Pu DM. Isolation and identification of epithelial and stromal stem cells from eutopic endometrium of women with endometriosis. Eur J Obstet Gynecol Reprod Biol 2014; 178:89-94. [PMID: 24792664 DOI: 10.1016/j.ejogrb.2014.04.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 03/03/2014] [Accepted: 04/02/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The recent characterization of possible stem/progenitor cells in the endometrium has shed new light on the origins of ectopic endometrial tissue and the mechanism for the pathogenesis of endometriosis, but has raised new questions. Is it possible that abnormal endometrial stem/progenitor cells increase their capacity to implant and establish themselves as ectopic tissue, or that normal stem cells implant in abnormal peritoneum? This study investigated key stem cell properties in cologenic epithelial and stromal cells obtained from eutopic endometrium of women with endometriosis. STUDY DESIGN Single cell suspensions of endometrial epithelial and stromal cells were cultured at densities of 20, 50, 100 and 200cells/cm(2). Cloning efficiency (CE) was determined, and stem cell phenotypic surface markers were detected using Western blotting and quantitative real-time polymerase chain reaction. RESULTS CE was significantly higher in cells cultured at a density of 50cells/cm(2) compared with the other groups. After 15 days of culture, small and large colonies were observed. Large-colony-derived epithelial and stromal cells had high proliferative potentials, producing millions of cells in vitro, with strong expression of epithelial and stromal stem cell phenotypic surface markers EMA, CK, CD49f, THY-1(CD90), collagen type I, 5B5 and vimentin. CONCLUSION Adult stem cells were found in eutopic endometrium of women with endometriosis, and this may play an important role in disease development.
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Affiliation(s)
- T Li
- Department of Obstetrics and Gynaecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - H He
- Department of Obstetrics and Gynaecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - R Liu
- Department of Obstetrics and Gynaecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - S-X Wang
- Department of Obstetrics and Gynaecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - D-M Pu
- Department of Obstetrics and Gynaecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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177
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Affiliation(s)
- Jae-Wook Jeong
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, College of Human Medicine, Grand Rapids, Michigan 49503
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178
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Heard ME, Simmons CD, Simmen FA, Simmen RCM. Krüppel-like factor 9 deficiency in uterine endometrial cells promotes ectopic lesion establishment associated with activated notch and hedgehog signaling in a mouse model of endometriosis. Endocrinology 2014; 155:1532-46. [PMID: 24476135 PMCID: PMC3959595 DOI: 10.1210/en.2013-1947] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Endometriosis, a steroid hormone-dependent disease characterized by aberrant activation of estrogen receptor signaling and progesterone resistance, remains intractable because of the complexity of the pathways underlying its manifestation. We previously showed that eutopic endometria of women with endometriosis exhibit lower expression of Krüppel-like factor 9 (KLF9), a progesterone receptor coregulator in the uterus, relative to that of women without disease. Here we examined whether loss of endometrial KLF9 expression causes ectopic lesion establishment using syngeneic wild-type (WT) mice as recipients of endometrial fragments from WT and Klf9 null donors. We found significantly higher incidence of ectopic lesions with Klf9 null than WT endometria 8 weeks after tissue injection into the intraperitoneal cavity. The increased incidence of lesion establishment with Klf9 null endometria was associated with a higher expression ratio of estrogen receptor 2 isoform relative to that of estrogen receptor 1 and attenuated progesterone receptor levels in endometriotic stromal cells. PCR array analyses of Notch and Hedgehog signaling components in ectopic lesions demonstrated up-regulated expression of select genes (Jag 2, Shh, Gli1, and Stil 1) in Klf9 null lesions relative to that in WT lesions. Immunohistochemical analyses showed increased levels of Notch intracellular domain and Sonic Hedgehog proteins in Klf9 null lesions relative to that in WT lesions, confirming pathway activation. WT recipients with Klf9 null lesions displayed lower systemic levels of TNFα and IL-6 and higher soluble TNF receptor 1 than corresponding recipients with WT lesions. Our results suggest that endometrial KLF9 deficiency promotes endometriotic lesion establishment by the coincident deregulation of Notch-, Hedgehog-, and steroid receptor-regulated pathways.
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Affiliation(s)
- Melissa E Heard
- Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205
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Dracxler RC, Oh C, Kalmbach K, Wang F, Liu L, Kallas EG, Giret MTM, Seth-Smith ML, Antunes D, Keefe DL, Abrao MS. Peripheral blood telomere content is greater in patients with endometriosis than in controls. Reprod Sci 2014; 21:1465-71. [PMID: 24675987 DOI: 10.1177/1933719114527353] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
UNLABELLED The etiology of endometriosis remains poorly understood but circulating stem cells may contribute. Telomeres shorten with cell divisions and age. Stem cells attempt to compensate for telomere attrition through the action of telomerase. Since circulating stem cells may contribute to endometriosis, we compared telomere content in lymphocytes of patients with and without endometriosis. METHODS Observational study comparing peripheral lymphocytes telomere content, measured by quantitative polymerase chain reaction, in patients with (n = 86) and without endometriosis (n = 21). FINDINGS Patients with endometriosis had longer telomeres than that of matched, endometriosis-free controls (telomere to single copy gene ratio [T/S ratio] of 1.62 vs 1.34, respectively, P = .00002). Patients with endometriosis were 8.1-fold more likely to have long telomeres. (odds ratio = 8.1, 95% confidence interval: 1.28-51.57, P = .0264). INTERPRETATION Longer telomeres could be consistent with a stem cell origin of endometriosis.
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Affiliation(s)
- Roberta C Dracxler
- Obstetrics and Gynecology Department of New York University School of Medicine, New York, NY, USA Endometriosis Department of the Medical School of Sao Paulo University, Sao Paulo, SP, Brazil
| | - C Oh
- Obstetrics and Gynecology Department of New York University School of Medicine, New York, NY, USA
| | - K Kalmbach
- Obstetrics and Gynecology Department of New York University School of Medicine, New York, NY, USA
| | - F Wang
- Obstetrics and Gynecology Department of New York University School of Medicine, New York, NY, USA
| | - L Liu
- Obstetrics and Gynecology Department of New York University School of Medicine, New York, NY, USA
| | - E G Kallas
- Immunology Department of the Medical School of Sao Paulo University, Sao Paulo, SP, Brazil
| | - M T M Giret
- Immunology Department of the Medical School of Sao Paulo University, Sao Paulo, SP, Brazil
| | - M L Seth-Smith
- Obstetrics and Gynecology Department of New York University School of Medicine, New York, NY, USA
| | - D Antunes
- Obstetrics and Gynecology Department of New York University School of Medicine, New York, NY, USA
| | - D L Keefe
- Obstetrics and Gynecology Department of New York University School of Medicine, New York, NY, USA
| | - M S Abrao
- Endometriosis Department of the Medical School of Sao Paulo University, Sao Paulo, SP, Brazil
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180
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Gargett CE, Schwab KE, Brosens JJ, Puttemans P, Benagiano G, Brosens I. Potential role of endometrial stem/progenitor cells in the pathogenesis of early-onset endometriosis. Mol Hum Reprod 2014; 20:591-8. [DOI: 10.1093/molehr/gau025] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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181
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Hsu CY, Hsieh TH, Tsai CF, Tsai HP, Chen HS, Chang Y, Chuang HY, Lee JN, Hsu YL, Tsai EM. miRNA-199a-5p regulates VEGFA in endometrial mesenchymal stem cells and contributes to the pathogenesis of endometriosis. J Pathol 2014; 232:330-43. [PMID: 24155090 DOI: 10.1002/path.4295] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 10/03/2013] [Accepted: 10/18/2013] [Indexed: 12/12/2022]
Abstract
It is believed that endometrial miRNAs contribute to the aetiology of endometriosis in stem cells; however, the mechanisms remain unclear. Here we collected serum samples from patients with or without endometriosis and characterized the miRNA expression profiles of these two groups. MicroRNA-199a-5p (miR-199a-5p) was dramatically down-regulated in patients with endometriosis compared with control patients. In addition, we found that the tumour suppressor gene, SMAD4, could elevate miR-199a-5p expression in ectopic endometrial mesenchymal stem cells. Up-regulation of miR-199a-5p suppressed cell proliferation, motility and angiogenesis of these ectopic stem cells by targeting the 3' untranslated region of VEGFA. Furthermore, we established an animal model of endometriosis and found that miR-199a-5p could decrease the size of endometriotic lesions in vivo. Taken together, this newly identified miR-199a-5p module provides a new avenue to the understanding of the processes of endometriosis development, especially proliferation, motility and angiogenesis, and may facilitate the development of potential therapeutics against endometriosis.
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Affiliation(s)
- Chia-Yi Hsu
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan, Republic of China
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182
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Theories on the pathogenesis of endometriosis. Int J Reprod Med 2014; 2014:179515. [PMID: 25763392 PMCID: PMC4334056 DOI: 10.1155/2014/179515] [Citation(s) in RCA: 219] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 01/06/2014] [Indexed: 12/18/2022] Open
Abstract
Endometriosis is a common, chronic inflammatory disease defined by the presence of extrauterine endometrial tissue. The aetiology of endometriosis is complex and multifactorial, where several not fully confirmed theories describe its pathogenesis. This review examines existing theories on the initiation and propagation of different types of endometriotic lesions, as well as critically appraises the myriad of biologically relevant evidence that support or oppose each of the proposed theories. The current literature suggests that stem cells, dysfunctional immune response, genetic predisposition, and aberrant peritoneal environment may all be involved in the establishment and propagation of endometriotic lesions. An orchestrated scientific and clinical effort is needed to consider all factors involved in the pathogenesis of this multifaceted disease and to propose novel therapeutic targets to reach effective treatments for this distressing condition.
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184
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Mafra FA, Christofolini DM, Cavalcanti V, Vilarino FL, André GM, Kato P, Bianco B, Barbosa CP. Aberrant Telomerase Expression in the Endometrium of Infertile Women with Deep Endometriosis. Arch Med Res 2014; 45:31-5. [DOI: 10.1016/j.arcmed.2013.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 10/11/2013] [Indexed: 01/21/2023]
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185
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Sayegh L, Fuleihan GEH, Nassar AH. Vitamin D in endometriosis: a causative or confounding factor? Metabolism 2014; 63:32-41. [PMID: 24135500 DOI: 10.1016/j.metabol.2013.09.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 09/16/2013] [Accepted: 09/16/2013] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim of this paper is to review the evidence from studies that evaluated the relationship between vitamin D and endometriosis. DESIGN Comprehensive review. MATERIALS AND METHODS Systematic literature search in Medline for relevant publications from 1946 until June 2013. RESULTS Endometriosis risk may be influenced by dietary vitamin D intake and plasma hydroxyvitamin D concentration. Vitamin D receptor and vitamin D metabolizing enzymes, 24-hydroxylase and 1-α hydroxylase, are found in the normal cycling endometrium and also in the eutopic and ectopic endometrium of women with endometriosis. The endometrium is a target of 1, 25 dihydroxyvitamin D actions through regulation of specific genes and via immunomodulation. The endometrium in endometriosis expresses dysregulation of some vitamin D enzymes and receptors. If vitamin D and its metabolites are implicated in endometriosis-associated infertility, it is likely through interference with HOXA10 gene expression. The Gc2 phenotype of vitamin D binding protein is prevalent in women with endometriosis and may be implicated in its pathogenesis. In a mouse model, Elocalcitol, a VDR-agonist was shown to reduce the development of endometriotic lesions and recurrence. CONCLUSION A biological plausibility for a role of vitamin D, as an immunomodulator and anti-inflammatory agent, in the pathogenesis and treatment of endometriosis is suggested in this article, but is difficult to illustrate due to sparse evidence from human studies limited primarily to case-control studies. A significant knowledge gap precludes the establishment of a clear cause-effect relationship. The intriguing leads presented herein need to be investigated further with placebo-controlled supplementation trials.
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Affiliation(s)
- Lamia Sayegh
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
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186
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Khan KN, Fujishita A, Kitajima M, Hiraki K, Nakashima M, Masuzaki H. Occult microscopic endometriosis: undetectable by laparoscopy in normal peritoneum. Hum Reprod 2013; 29:462-72. [PMID: 24352888 DOI: 10.1093/humrep/det438] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
STUDY QUESTION Is there any occurrence of hidden (occult) endometriotic lesions in normal peritoneum of women with and without visible endometriosis? SUMMARY ANSWER We detected a slightly higher occurrence of occult microscopic endometriosis (OME) in normal peritoneum of women with visible endometriosis than in control women. WHAT IS KNOWN ALREADY Based on a small number of cases, the concept of invisible microscopic endometriosis in visually normal peritoneum has been reported for more than a decade but there is controversy regarding their tissue activity and clinical significance. STUDY DESIGN, SIZE, DURATION This case-controlled research study was conducted with prospectively collected normal peritoneal samples from 151 women with and 62 women without visible endometriosis. PARTICIPANTS/MATERIALS, SETTING, METHODS Normal peritoneal biopsy specimens from different pelvic sites of were collected during laparoscopy. A histological search of all peritoneal biopsy specimens for the detection of invisible endometriosis was done by immunoreaction to Ber-EP4 (epithelial cell marker), CD10 (stromal cell marker) and Calretinin (mesothelial cell marker). Tissue expression of estrogen/progesterone receptors (ER/PR) and cell proliferation marker, Ki-67, was performed by immunohistochemistry to identify tissue activity. MAIN RESULTS AND THE ROLE OF CHANCE Three different patterns of OME were detected based on (I) the presence of typical gland/stroma, (II) reactive hyperplastic change of endometrioid epithelial cells with surrounding stroma and (III) single-layered epithelium-lined cystic lesions with surrounding stroma. A higher tendency toward the occurrence of OME was found in women with visible endometriosis (15.2%, 23/151) compared with control women (6.4%, 4/62) (P = 0.06, χ(2) test). The epithelial cells and/or stromal cells of OME lesions were immunoreactive to Ber-EP4 and CD10 but not reactive to Calretinin. ER and PR expression was observed in all patterns of OME lesions. Ki-67 index was significantly higher in pattern I/II OME lesions than in pattern III OME lesions (P< 0.05 for each). LIMITATIONS, REASONS FOR CAUTION Bias in the incidence rate of OME lesions in this study cannot be ignored, because we could not analyze biopsy specimens from the Pouch of Douglas of women with revised classification of the American Society of Reproductive Medicine Stage III-IV endometriosis due to the presence of adhesions in the pelvis. WIDER IMPLICATIONS OF THE FINDINGS We re-confirmed a decade long old concept of invisible (occult) endometriosis in visually normal peritoneum of women with visible endometriosis. The existence of a variable amount of tissue activity in these occult lesions may contribute to the recurrence/occurrence of endometriosis or persistence/recurrence of pain manifestation in women even after successful ablation or excision of visible lesions by laparoscopy. STUDY FUNDING/COMPETING INTEREST(S) This work was supported in part by Grants-in-aid for Scientific Research from the Japan Society for the Promotion of Science. There is no conflict of interest related to this study. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- Khaleque Newaz Khan
- Department of Obstetrics and Gynecology, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
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187
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Scheel AH, Frasunek J, Meyer W, Ströbel P. Cystic endosalpingiosis presenting as chronic back pain, a case report. Diagn Pathol 2013; 8:196. [PMID: 24299296 PMCID: PMC3924907 DOI: 10.1186/1746-1596-8-196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 10/08/2013] [Indexed: 11/10/2022] Open
Abstract
A 48-year old woman presented with chronic back pain. Previous examinations had been inconclusive. Gynaecological examination revealed large cystic masses on the fundus uteri and left adnexa. Laparoscopy and histopathology showed unusually extensive cystic endosalpingiosis covering the serosa-coated uterine surface as well as the adnexa on both sides. After uneventful laparoscopic-assisted vaginal hysterectomy the patient quickly recovered and was relieved of her chronic backache. Virtual slides: http://www.diagnosticpathology.diagnomx.eu/vs/1501709091077524.
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Affiliation(s)
- Andreas H Scheel
- Department of Pathology, University Medical Center Göttingen, Göttingen, Germany
- Institute of Pathology Nordhessen, Kassel, Germany
| | - Josef Frasunek
- Department of Gynaecology, Helios Albert-Schweitzer-Klinik Northeim, Northeim, Germany
| | - Werner Meyer
- Department of Pathology, University Medical Center Göttingen, Göttingen, Germany
- Institute of Pathology Nordhessen, Kassel, Germany
| | - Philipp Ströbel
- Department of Pathology, University Medical Center Göttingen, Göttingen, Germany
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188
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Genetic Polymorphisms Associated with Endometriosis in Pakistani Women. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2013. [DOI: 10.5301/je.5000165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Endometriosis is a common disease that causes pain and infertility. The heritable predisposition toward endometriosis motivates an interest to identify the genes and genomic variants involved in the pathogenesis of endometriosis. Both genetic and environmental factors contribute to this disease. Here we investigated in Pakistani women the association of endometriosis and single nucleotide polymorphisms (SNP) in genes previously identified in the development of this disease. Methods DNA samples from 52 genetically unrelated endometriosis subjects with endometriosis and 52 randomly selected controls were analyzed by direct sequencing to determine polymorphisms in four genes. These included estrogen receptor alpha (ESR1) (rs2234693 C/T, rs9340799 G/A SNP), estrogen receptor beta (ESR2) (rs4986938 G/A SNP), progesterone receptor (PGR) (rs1042838 G/T, rs10895068 G/A SNPs) and interleukin 10 (IL10) (rs1800871 C/T, rs1800872 C/A and rs1800896 G/A SNPs). Results The allele A at −592, T at −819 and G at −1080 of IL10 and all of the SNPs studied at ESR2 and PGR show strong, statistically significant associations with the disease. However, the genetic variation at ESR1 was distributed similarly among cases and control groups. Conclusion These findings suggest that the functional promoter polymorphism of the IL10 gene, identified by the “ATG” genotype, may contribute to the risk of endometriosis. Genetic variants of ESR2 and PGR gene may also be a risk factor as well as influence the fertility status of patients with endometriosis.
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189
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Genetic, epigenetic and stem cell alterations in endometriosis: new insights and potential therapeutic perspectives. Clin Sci (Lond) 2013; 126:123-38. [PMID: 24059589 DOI: 10.1042/cs20130099] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Human endometrium is a highly dynamic tissue, undergoing periodic growth and regression at each menstrual cycle. Endometriosis is a frequent chronic pathological status characterized by endometrial tissue with an ectopic localization, causing pelvic pain and infertility and a variable clinical presentation. In addition, there is well-established evidence that, although endometriosis is considered benign, it is associated with an increased risk of malignant transformation in approximately 1.0% of affected women, with the involvement of multiple pathways of development. Increasing evidence supports a key contribution of different stem/progenitor cell populations not only in the cyclic regeneration of eutopic endometrium, but also in the pathogenesis of at least some types of endometriosis. Evidence has arisen from experiments in animal models of disease through different kinds of assays (including clonogenicity, the label-retaining cell approach, the analysis of undifferentiation markers), as well as from descriptive studies on ectopic and eutopic tissue samples harvested from affected women. Changes in stem cell populations in endometriotic lesions are associated with genetic and epigenetic alterations, including imbalance of miRNA expression, histone and DNA modifications and chromosomal aberrations. The present short review mainly summarizes the latest observations contributing to the current knowledge regarding the presence and the potential contribution of stem/progenitor cells in eutopic endometrium and the aetiology of endometriosis, together with a report of the most recently identified genetic and epigenetic alterations in endometriosis. We also describe the potential advantages of single cell molecular profiling in endometrium and in endometriotic lesions. All these data can have clinical implications and provide a basis for new potential therapeutic applications.
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190
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Epithelial-to-mesenchymal transition and stem cells in endometrial cancer. Hum Pathol 2013; 44:1973-81. [DOI: 10.1016/j.humpath.2013.04.009] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 04/12/2013] [Accepted: 04/17/2013] [Indexed: 12/28/2022]
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191
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Hwang JH, Wang T, Lee KS, Joo JK, Lee HG. Vitamin D binding protein plays an important role in the progression of endometriosis. Int J Mol Med 2013; 32:1394-400. [PMID: 24064663 DOI: 10.3892/ijmm.2013.1506] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 08/29/2013] [Indexed: 11/06/2022] Open
Abstract
Endometriosis, characterized by the growth of the endometrial gland and stroma outside the uterine cavity, is a gynecological disorder affecting 6‑10% of women of reproductive age. However, the pathogenesis of endometriosis and the molecular mechanisms involved in the progression of this disease remain to be clarified. Therefore, in this study two-dimensional gel electrophoresis (2‑DE) combined with mass spectrometry (MS) were applied to explore endometrial proteins with a role in the progression of endometriosis. Expression of global proteins in ectopic endometrial tissue (n=13; endometriosis group) was compared with that of the normal endometrial tissue (n=6; control group). Sixteen differently expressed proteins, including Vitamin D binding protein (DBP), with various functions were primarily identified in the ectopic endometrial tissue. DBP was confirmed to be significantly increased in the ectopic endometrial tissue compared with that in the normal endometrial tissue (P<0.05). Results of the present study therefore showed that DBP may play an important role in the progression of endometriosis.
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Affiliation(s)
- Jin-Hee Hwang
- Department of Animal Science and Technology, College of Animal Bioscience and Technology, Konkuk University, Seoul 143-701, Republic of Korea
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192
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Pittatore G, Moggio A, Benedetto C, Bussolati B, Revelli A. Endometrial Adult/Progenitor Stem Cells. Reprod Sci 2013; 21:296-304. [DOI: 10.1177/1933719113503405] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- G. Pittatore
- Department of Surgical Sciences, Physiopathology of Reproduction and IVF Unit, University of Torino, S. Anna Hospital, Torino, Italy
| | - A. Moggio
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Torino, Torino, Italy
| | - C. Benedetto
- Department of Surgical Sciences, Physiopathology of Reproduction and IVF Unit, University of Torino, S. Anna Hospital, Torino, Italy
| | - B. Bussolati
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Torino, Torino, Italy
| | - A. Revelli
- Department of Surgical Sciences, Physiopathology of Reproduction and IVF Unit, University of Torino, S. Anna Hospital, Torino, Italy
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193
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Eutopic and ectopic stromal cells from patients with endometriosis exhibit differential invasive, adhesive, and proliferative behavior. Fertil Steril 2013; 100:761-9. [DOI: 10.1016/j.fertnstert.2013.04.041] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 04/16/2013] [Accepted: 04/25/2013] [Indexed: 01/21/2023]
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194
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HWANG JINHEE, OH JINJU, WANG TAO, JIN YONGCHENG, LEE JAESUNG, CHOI JONGRYEOL, LEE KYUSUP, JOO JONGKIL, LEE HONGGU. Identification of biomarkers for endometriosis in eutopic endometrial cells from patients with endometriosis using a proteomics approach. Mol Med Rep 2013; 8:183-8. [DOI: 10.3892/mmr.2013.1469] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 03/15/2013] [Indexed: 11/06/2022] Open
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195
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Bruner-Tran KL, Herington JL, Duleba AJ, Taylor HS, Osteen KG. Medical management of endometriosis: emerging evidence linking inflammation to disease pathophysiology. MINERVA GINECOLOGICA 2013; 65:199-213. [PMID: 23598784 PMCID: PMC3718308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Progesterone action normally mediates the balance between anti-inflammatory and proinflammatory processes throughout the female reproductive tract. However, in women with endometriosis, endometrial progesterone resistance, characterized by alterations in progesterone responsive gene and protein expression, is now considered a central element in disease pathophysiology. Recent studies additionally suggest that the peritoneal microenvironment of endometriosis patients exhibits altered physiological characteristics that may further promote inflammation-driven disease development and progression. Within this review, we summarize our current understanding of the pathogenesis of endometriosis with an emphasis on the role that inflammation plays in generating not only the progesterone-resistant eutopic endometrium but also a peritoneal microenvironment that may contribute significantly to disease establishment. Viewing endometriosis from the emerging perspective that a progesterone resistant endometrium and an immunologically compromised peritoneal microenvironment are biologically linked risk factors for disease development provides a novel mechanistic framework to identify new therapeutic targets for appropriate medical management.
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Affiliation(s)
- Kaylon L. Bruner-Tran
- Women's Reproductive Health Research Center, Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, TN USA 37232
| | - Jennifer L. Herington
- Women's Reproductive Health Research Center, Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, TN USA 37232
| | - Antoni J. Duleba
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of California Davis, Sacramento, California USA 95817
| | - Hugh S. Taylor
- Department of Obstetrics and Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT USA 06510
| | - Kevin G. Osteen
- Women's Reproductive Health Research Center, Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, TN USA 37232
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196
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Atypical Expression of COX-2, StAR, CYP19A1 and Apoptotic Regulators in CD90 Positive Endometrial Stromal Cells from Women with Endometriosis. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2013. [DOI: 10.5301/je.5000149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose Endometriosis is an invasive gynecologic disease characterized by diminished apoptosis, sustained ectopic survival of dysfunctional endometrial cells and implantation of endometriotic lesions outside of the uterus. The purpose of this investigation was to determine the expression pattern of apoptotic and steroidogenic genes in the progenitor stem cell population of eutopic tissues from women with endometriosis and compare them to controls. The expression of these genes was determined in a subpopulation of endometrial cells that displayed CD90 positivity (CD+ve90) and colony forming capacity. Methods We obtained endometrial samples from women with or without endometriosis. Endometrial stromal cells (ESCs) were isolated and cultured for 15 days. Purified ESCs were sorted by using a multipotent mesenchymal stromal cell multi-color flow cytometry kit. Single cell cloning was performed by serial dilution in 96-micro well plates. Fifteen days later, colonies were identified (CFUs). The colonies were chosen and cultured. mRNA expression of apoptotic genes, mitogen activated kinase 14 (MAPK14), nuclear factor kappa B (NFkB), steroidogenic acute regulatory protein (StAR), aromatase (CYP19A1) and cyclo-oxygenase-2 (COX-2) were determined by qRT-PCR. Protein levels of StAR, CYP19A1 and COX-2 were determined by western blotting. Results A subset of stromal cells derived from women with endometriosis were isolated and identified as progenitor stem cells based on their CD90 positivity and colony forming ability. The cells displayed increased levels of MAPK14, NFkB, COX-2, StAR and CYP19A1 both at the mRNA and protein level compared to stromal cells derived from controls. Similarly, pro-apoptotic molecules such as Bax were decreased whereas anti-apoptotic molecules such as Bcl2 were decreased at the mRNA level compared to stromal cells derived from controls. Conclusions CD90+ve ESCs derived from women with endometriosis displayed markers suggesting stem cell-like properties and aberrant expression of apoptotic and steroidogenic enzymes which may contribute to sustained survival of these cells.
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197
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D'Amico F, Skarmoutsou E, Quaderno G, Malaponte G, La Corte C, Scibilia G, D'Agate G, Scollo P, Fraggetta F, Spandidos DA, Mazzarino MC. Expression and localisation of osteopontin and prominin-1 (CD133) in patients with endometriosis. Int J Mol Med 2013; 31:1011-6. [PMID: 23545719 PMCID: PMC3658602 DOI: 10.3892/ijmm.2013.1325] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 03/28/2013] [Indexed: 11/17/2022] Open
Abstract
In this study, we investigated the expression and localisation of the proteins, osteopontin (OPN) and prominin-1 (CD133), as well as the plasma OPN levels in the endometrium of patients with endometriosis. Samples of ectopic endometriotic lesions and normal endometrium were obtained from 31 women with endometriosis and 28 healthy control subjects. The mRNA and protein expression of OPN and CD133 was analysed by real-time RT-PCR and immunohistochemistry. The plasma levels of OPN were determined by ELISA. Our results revealed that OPN mRNA and protein expression, as well as its release in the blood, was significantly increased in the endometriotic lesions in comparison to normal tissue. Although the presence of CD133+ cells was detected in the normal endometrium, as well as in the endometriosis specimens, a significant quantitative variation of this protein was not demonstrated in the patients with endometriosis. In conclusion, our data indicate that OPN is involved in the development of endometriosis by enhancing the invasiveness, proliferation and survival of endometrial cells in ectopic lesions. CD133 cannot be used as a disease marker for endometriosis, although an involvement of this protein in the pathogenesis of endometriosis cannot be excluded.
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Affiliation(s)
- Fabio D'Amico
- Department of Biomedical Sciences, Pathology and Oncology Unit, University of Catania, Catania, Italy.
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198
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Ergenoğlu AM, Yeniel AÖ, Erbaş O, Aktuğ H, Yildirim N, Ulukuş M, Taskiran D. Regression of endometrial implants by resveratrol in an experimentally induced endometriosis model in rats. Reprod Sci 2013; 20:1230-6. [PMID: 23536571 DOI: 10.1177/1933719113483014] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the effect of resveratrol on an experimentally induced endometriosis rat model. STUDY DESIGN After endometriotic implants were surgically formed, rats were randomly divided into 2 groups as control group (saline treated, n = 6) and resveratrol group (10 mg/kg/d, n = 6). The inflammatory markers and histopathological changes were assessed at the end of the treatment period. Results Our results showed (1) significant reduction in the implant size (P < .0005); (2) significantly decreased levels of vascular endothelial growth factor (VEGF) in the peritoneal fluid and plasma (P < .005); and monocyte chemotactic protein 1 (MCP-1) in the peritoneal fluid (P < .05), (3) highly significant suppression of VEGF expression in the endometriotic tissue (P < .0005); and (4) considerable histological changes in the endometriotic foci following resveratrol treatment. CONCLUSION Resveratrol appears to be effective on the development of endometriosis through its antiangiogenic and anti-inflammatory properties. Future studies with different doses of resveratrol might provide more comprehensive results regarding the treatment of endometriosis.
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Affiliation(s)
- Ahmet Mete Ergenoğlu
- 1Department of Obstetrics and Gynaecology, Ege University School of Medicine, Izmir, Turkey
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Stilley JAW, Birt JA, Sharpe-Timms KL. Cellular and molecular basis for endometriosis-associated infertility. Cell Tissue Res 2013; 349:849-62. [PMID: 22298022 PMCID: PMC3429772 DOI: 10.1007/s00441-011-1309-0] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 12/06/2011] [Indexed: 11/28/2022]
Abstract
Endometriosis is a gynecological disease characterized by the presence of endometrial glandular epithelial and stromal cells growing in the extra-uterine environment. The disease afflicts 10%–15% of menstruating women causing debilitating pain and infertility. Endometriosis appears to affect every part of a woman’s reproductive system including ovarian function, oocyte quality, embryo development and implantation, uterine function and the endocrine system choreographing the reproductive process and results in infertility or spontaneous pregnancy loss. Current treatments are laden with menopausal-like side effects and many cause cessation or chemical alteration of the reproductive cycle, neither of which is conducive to achieving a pregnancy. However, despite the prevalence, physical and psychological tolls and health care costs, a cure for endometriosis has not yet been found. We hypothesize that endometriosis causes infertility via multifaceted mechanisms that are intricately interwoven thereby contributing to our lack of understanding of this disease process. Identifying and understanding the cellular and molecular mechanisms responsible for endometriosis-associated infertility might help unravel the confounding multiplicities of infertility and provide insights into novel therapeutic approaches and potentially curative treatments for endometriosis.
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Affiliation(s)
- Julie A W Stilley
- Division of Reproductive and Perinatal Research, Department of Obstetrics, Gynecology and Women's Health, The University of Missouri School of Medicine, Columbia, 65212, USA
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Indumathi S, Harikrishnan R, Rajkumar JS, Sudarsanam D, Dhanasekaran M. Prospective biomarkers of stem cells of human endometrium and fallopian tube compared with bone marrow. Cell Tissue Res 2013; 352:537-49. [PMID: 23460308 DOI: 10.1007/s00441-013-1582-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 02/05/2013] [Indexed: 12/20/2022]
Abstract
The applicability of stem cells from the human endometrium and fallopian tube for regeneration is a fascinating area of research because of the role of these cells in dynamic tissue remodelling and their cyclical regenerative property during the menstrual cycle and pregnancy. Nevertheless, studies on the identity of biomarkers of these stem cells are limited and need to be extended. The present study has aimed at exploring the tissue-specific biomarkers of stem cells derived from the human endometrium and fallopian tube compared with those from bone marrow. Cells were isolated from human endometrium and fallopian tubes and characterized for biomarkers, including CD34, CD133, CD117, CD90, CD105, CD73, nestin, CD29, CD44, CD31, CD54, CD166, CD106, CD49d, CD45, ABCG2, SSEA4, OCT4, SOX2, CD140b and CD146, by flowcytometry. Both endometrium and fallopian tube sources exhibited positivity over a wide range of markers, as did bone marrow. In particular, they exhibited pluripotency, perivascular and mesenchymal stem cell markers and cell adhesion molecules, thereby suggesting their relevance in tissue repair and regeneration. Overall, the results of this study provide evidence for the presence of stem cells in the human endometrium and fallopian tube, which could thus represent additional stem cell sources for regenerative medicine.
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Affiliation(s)
- S Indumathi
- Department of Advanced Zoology and Biotechnology, Loyola College, Chennai, India
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