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da Silva MCM, Ferreira LPDS, Della Giustina A. It is time to change the definition: Endometriosis is no longer a pelvic disease. Clinics (Sao Paulo) 2024; 79:100326. [PMID: 38325019 PMCID: PMC10862498 DOI: 10.1016/j.clinsp.2024.100326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/15/2023] [Accepted: 01/07/2024] [Indexed: 02/09/2024] Open
Affiliation(s)
| | - Luiz Philipe de Souza Ferreira
- Department of Morphology and Genetics, Structural and Functional Biology Graduate Program, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Amanda Della Giustina
- Sprott Centre for Stem Cell Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
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2
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Gete DG, Doust J, Mortlock S, Montgomery G, Mishra GD. Associations between endometriosis and common symptoms: findings from the Australian Longitudinal Study on Women's Health. Am J Obstet Gynecol 2023; 229:536.e1-536.e20. [PMID: 37499990 DOI: 10.1016/j.ajog.2023.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/28/2023] [Accepted: 07/21/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Endometriosis has been linked to higher rates of a variety of symptoms; however, the findings from longitudinal studies are scarce and inconsistent. OBJECTIVE This study aimed to examine the association between endometriosis and common symptoms in a prospective cohort study. STUDY DESIGN This study included 7606 women born from 1973 to 1978 using data from the Australian Longitudinal Study on Women's Health that were collected every 3 years from 2009 to 2018. We identified women with endometriosis based on self-reported incidence from each survey and linked administrative health data. At each survey, women also completed a checklist on the presence of 24 symptoms. Generalized estimating equations for multinomial responses were used for analyses. RESULTS Women with endometriosis had significantly more menstrual symptoms than those without endometriosis with an adjusted odds ratio (95% confidence interval) of 3.61 (3.11-4.19) for severe period pain, 2.40 (2.10-2.74) for heavy menstrual bleeding, 1.76 (1.52-2.03) for irregular bleeding, and 1.52 (1.32-1.76) for premenstrual tension. They also had higher odds of mental health problems with adjusted odds ratios of 1.67 (1.39-2.01) for depression and 1.59 (1.24-2.03) for anxiety and higher odds of allergies and nonspecific symptoms with adjusted odds of 1.62 (1.40-1.89) for allergies or hay fever or sinusitis, 1.79 (1.56-2.05) for severe tiredness, 1.56 (1.35-1.81) for sleep difficulty, and 1.77 (1.37-2.18) for palpitations. There was also a strong association with other forms of pain with an adjusted odds ratio of 1.76 (1.53-2.04) for backpain, 1.50 (1.29-1.74) for headaches or migraines, and 1.65 (1.41-1.93) for stiff or painful joints. Women with endometriosis also had increased odds of developing bowel and urinary symptoms with an adjusted odds ratio (95% confidence interval) of 1.67 (1.35-2.08) for constipation, 1.46 (1.12-1.90) for hemorrhoids or piles, 1.25 (1.03-1.52) for indigestion or heartburn, 2.80 (1.71-4.58) for urine burn or stings, and 1.37 (1.03-1.82) for vaginal discharge or irritation. The association between each symptom and endometriosis was similar whether endometriosis was surgically confirmed or clinically suspected. No association was found between endometriosis and the risk for skin problems, leaking urine, or breathing difficulty. CONCLUSION This study suggests that women with endometriosis are more likely to report not only menstrual symptoms but are also at an increased risk for mental health problems, other pain symptoms, bowel and urinary symptoms, and nonspecific symptoms, such as severe tiredness and difficulty sleeping.
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Affiliation(s)
- Dereje G Gete
- Australian Woman and Girls' Health Research Centre, School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Jenny Doust
- Australian Woman and Girls' Health Research Centre, School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Sally Mortlock
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia
| | - Grant Montgomery
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia
| | - Gita D Mishra
- Australian Woman and Girls' Health Research Centre, School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
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3
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van Stein K, Schubert K, Ditzen B, Weise C. Understanding Psychological Symptoms of Endometriosis from a Research Domain Criteria Perspective. J Clin Med 2023; 12:4056. [PMID: 37373749 DOI: 10.3390/jcm12124056] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/07/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Endometriosis is currently the second most common gynecological disease and is associated with severe pain, vegetative impairment, and infertility. In association, there are considerable psychological symptoms that limit the quality of life of those affected. In this narrative review, the Research Domain Criteria (RDoC) framework was utilized to display the different transdiagnostic processes involved in disease progression and maintenance in regard to psychosocial functioning. Using the RDoC framework, it becomes clear that immune/endocrinological dysregulation is interlocked with (pelvic) pain chronification processes and psychological symptoms such as depressive mood, loss of control, higher vigilance toward the onset or worsening of symptoms, social isolation, and catastrophizing. This paper will discuss and identify promising treatment approaches, in addition to medical care, as well as further research implications. Endometriosis can come with substantial psychosomatic and social burden, requiring more research to understand the interdependence of different factors involved in its chronic development pathway. However, it is already clear that standard care should be extended with multifaceted treatments addressing pain, as well as the psychological and social burden, in order to halt the cycle of aggravation of symptoms and to improve quality of life for patients.
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Affiliation(s)
- Katharina van Stein
- Heidelberg University Hospital, Institute for Medical Psychology, 69115 Heidelberg, Germany
- Faculty of Behavioral and Cultural Studies, Ruprecht Karls-University, 69115 Heidelberg, Germany
| | - Kathrin Schubert
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, 35032 Marburg, Germany
| | - Beate Ditzen
- Heidelberg University Hospital, Institute for Medical Psychology, 69115 Heidelberg, Germany
- Faculty of Behavioral and Cultural Studies, Ruprecht Karls-University, 69115 Heidelberg, Germany
| | - Cornelia Weise
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, 35032 Marburg, Germany
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4
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Vannuccini S, Clemenza S, Rossi M, Petraglia F. Hormonal treatments for endometriosis: The endocrine background. Rev Endocr Metab Disord 2022; 23:333-355. [PMID: 34405378 PMCID: PMC9156507 DOI: 10.1007/s11154-021-09666-w] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 12/25/2022]
Abstract
Endometriosis is a benign uterine disorder characterized by menstrual pain and infertility, deeply affecting women's health. It is a chronic disease and requires a long term management. Hormonal drugs are currently the most used for the medical treatment and are based on the endocrine pathogenetic aspects. Estrogen-dependency and progesterone-resistance are the key events which cause the ectopic implantation of endometrial cells, decreasing apoptosis and increasing oxidative stress, inflammation and neuroangiogenesis. Endometriotic cells express AMH, TGF-related growth factors (inhibin, activin, follistatin) CRH and stress related peptides. Endocrine and inflammatory changes explain pain and infertility, and the systemic comorbidities described in these patients, such as autoimmune (thyroiditis, arthritis, allergies), inflammatory (gastrointestinal/urinary diseases) and mental health disorders.The hormonal treatment of endometriosis aims to block of menstruation through an inhibition of hypothalamus-pituitary-ovary axis or by causing a pseudodecidualization with consequent amenorrhea, impairing the progression of endometriotic implants. GnRH agonists and antagonists are effective on endometriosis by acting on pituitary-ovarian function. Progestins are mostly used for long term treatments (dienogest, NETA, MPA) and act on multiple sites of action. Combined oral contraceptives are also used for reducing endometriosis symptoms by inhibiting ovarian function. Clinical trials are currently going on selective progesterone receptor modulators, selective estrogen receptor modulators and aromatase inhibitors. Nowadays, all these hormonal drugs are considered the first-line treatment for women with endometriosis to improve their symptoms, to postpone surgery or to prevent post-surgical disease recurrence. This review aims to provide a comprehensive state-of-the-art on the current and future hormonal treatments for endometriosis, exploring the endocrine background of the disease.
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Affiliation(s)
- Silvia Vannuccini
- Obstetrics and Gynecology, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Florence, Italy
| | - Sara Clemenza
- Obstetrics and Gynecology, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Florence, Italy
| | - Margherita Rossi
- Obstetrics and Gynecology, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Florence, Italy
| | - Felice Petraglia
- Obstetrics and Gynecology, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Florence, Italy.
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5
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Schubert K, Lohse J, Kalder M, Ziller V, Weise C. Internet-based cognitive behavioral therapy for improving health-related quality of life in patients with endometriosis: study protocol for a randomized controlled trial. Trials 2022; 23:300. [PMID: 35414092 PMCID: PMC9006397 DOI: 10.1186/s13063-022-06204-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/26/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The trial investigates the efficacy of internet-based cognitive behavioral therapy (iCBT) in improving health-related QoL in patients with endometriosis, which is a chronic gynecological condition affecting up to 15% of people with female-assigned reproductive organs. Endometriosis is stress-related and comes with various physical symptoms such as pelvic pain and infertility. It has a substantial impact on health-related quality of life (QoL), and mind-body interventions seem promising in reducing the psychological burden. METHODS This is a monocentric randomized-controlled trial recruiting 120 patients with endometriosis. The intervention consists of eight iCBT modules focusing on psychoeducation, cognitive restructuring, pacing, and emotion regulation. Participants will receive written feedback from a trained therapist weekly. The comparator is a waitlist control group. All participants will be followed up 3 months after the intervention, and the intervention group will additionally be followed up 12 months after the intervention. Trial participants will not be blinded to the allocated trial arm. Primary outcome measures are endometriosis-related QoL, pain, and pain-related disability. Secondary outcomes include coping, illness representations, and psychological flexibility. Statistical analyses will be performed following intention-to-treat principles. DISCUSSION This randomized-controlled trial is the first trial to test the efficacy of iCBT for improving endometriosis-related QoL. Potential predictor variables and key mechanisms in treatment will be investigated to enable further progression in medical and psychological care for patients with endometriosis. TRIAL REGISTRATION ClinicalTrials.gov , NCT05098444 Registered on October 28, 2021.
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Affiliation(s)
- Kathrin Schubert
- Dept. of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Johanna Lohse
- Dept. of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Matthias Kalder
- Clinic for Gynecology and Obstetrics, University Hospital of Giessen and Marburg (UKGM), Marburg, Germany
| | - Volker Ziller
- Clinic for Gynecology and Obstetrics, University Hospital of Giessen and Marburg (UKGM), Marburg, Germany
| | - Cornelia Weise
- Dept. of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany.
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6
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Márki G, Vásárhelyi D, Rigó A, Kaló Z, Ács N, Bokor A. Challenges of and possible solutions for living with endometriosis: a qualitative study. BMC Womens Health 2022; 22:20. [PMID: 35081940 PMCID: PMC8793269 DOI: 10.1186/s12905-022-01603-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/14/2022] [Indexed: 12/11/2022] Open
Abstract
Background Endometriosis as a chronic gynecological disease has several negative effects on women’s life, thereby placing a huge burden on the patients and the health system. The negative impact of living with endometriosis (impaired quality of life, diverse medical experiences) is detailed in the literature, however, we know less about patients’ self-management, social support, the meaning of life with a chronic disease, and the needs of patients. To implement a proper multidisciplinary approach in practice, we need to have a comprehensive view of the complexity of endometriosis patients’ life and disease history. Methods Four focus group discussions were conducted between October 2014 and November 2015 by a team consisting of medical and psychological specialists. 21 women (age: 31.57; SD = 4.45) with surgical and histological confirmation of endometriosis were included in the study. Discussions were audiotaped and transcribed verbatim, and a 62,051-word corpus was analyzed using content analysis. Results Four main themes emerged from the analysis: (1) the impact of endometriosis on quality of life, (2) medical experiences, (3) complementary and alternative treatments, and (4) different coping strategies in disease management. All themes were interrelated and highly affected by a lack of information and uncertainty caused by endometriosis. A supporting doctor-patient relationship, active coping, and social support were identified as advantages over difficulties. Finding the positive meaning of life after accepting endometriosis increased the possibility of posttraumatic growth. Furthermore, women’s needs were identified at all levels of the ecological approach to health promotion. Conclusions Our results highlight the need for multidisciplinary healthcare programs and interventions to find solutions to the difficulties of women with endometriosis. To achieve this goal, a collaboration of professionals, psychologists, and support organizations is needed in the near future.
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Affiliation(s)
- Gabriella Márki
- Doctoral School of Psychology, Eötvös Loránd University, Budapest, 1064, Hungary.,Institute of Psychology, Eötvös Loránd University, Izabella Street 46, Budapest, 1064, Hungary
| | - Dorottya Vásárhelyi
- Institute of Psychology, Eötvös Loránd University, Izabella Street 46, Budapest, 1064, Hungary
| | - Adrien Rigó
- Institute of Psychology, Eötvös Loránd University, Izabella Street 46, Budapest, 1064, Hungary
| | - Zsuzsa Kaló
- Institute of Psychology, Eötvös Loránd University, Izabella Street 46, Budapest, 1064, Hungary
| | - Nándor Ács
- Department of Obstetrics and Gynecology, Faculty of Medicine, Semmelweis University, Baross Street 27, Budapest, 1088, Hungary
| | - Attila Bokor
- Department of Obstetrics and Gynecology, Faculty of Medicine, Semmelweis University, Baross Street 27, Budapest, 1088, Hungary.
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7
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Chen X, Man GCW, Hung SW, Zhang T, Fung LWY, Cheung CW, Chung JPW, Li TC, Wang CC. Therapeutic effects of green tea on endometriosis. Crit Rev Food Sci Nutr 2021:1-14. [PMID: 34620005 DOI: 10.1080/10408398.2021.1986465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Endometriosis is a chronic disorder characterized by the presence of endometrial glands and stroma outside the uterine cavity. It affects 8%-10% of women in their reproductive years, and represents a major clinical problem with deleterious social, sexual and reproductive consequences. Current treatment options include pain relief, hormonal intervention and surgical removal. However, these treatments are deemed unsatisfactory owing to varying success, significant side effects and high recurrence rates. Green tea and its major bioactive component, (-)-epigallocatechin gallate (EGCG), possess diverse biological properties, particularly anti-angiogenic, anti-proliferation, anti-metastasis, and apoptosis induction. In recent years, preclinical studies have proposed the use of green tea to inhibit the growth of endometriosis. Herein, the aim of this review is to summarize the potential therapeutic effects of green tea on molecular and cellular mechanism through inflammation, oxidative stress, invasion and adhesion, apoptosis and angiogenesis in endometriosis.
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Affiliation(s)
- Xiaoyan Chen
- Department of Obstetrics and Gynaecology, Shenzhen Baoan Women's and Children's Hospital, Shenzhen University, Shenzhen, China.,Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Gene Chi Wai Man
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.,Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Sze Wan Hung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Tao Zhang
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Linda Wen Ying Fung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Chun Wai Cheung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Jacqueline Pui Wah Chung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Tin Chiu Li
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.,Li Ka Shing Institute of Health Sciences; School of Biomedical Sciences; Chinese University of Hong Kong-Sichuan University Joint Laboratory in Reproductive Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Chi Chiu Wang
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.,Li Ka Shing Institute of Health Sciences; School of Biomedical Sciences; Chinese University of Hong Kong-Sichuan University Joint Laboratory in Reproductive Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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8
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AlAshqar A, Reschke L, Kirschen GW, Borahay MA. Role of inflammation in benign gynecologic disorders: from pathogenesis to novel therapies†. Biol Reprod 2021; 105:7-31. [PMID: 33739368 PMCID: PMC8256101 DOI: 10.1093/biolre/ioab054] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 12/16/2022] Open
Abstract
Emerging evidence supports the notion that inflammation fosters the development of common benign gynecologic disorders, including uterine leiomyoma, endometriosis, and adenomyosis. Numerous cytokines, chemokines, and growth and transcription factors have indisputable roles in the establishment and maintenance of benign gynecologic disorders by initiating complex cascades that promote proliferation, angiogenesis, and lesion progression. The interaction between inflammation and benign gynecologic disorders is orchestrated by a plethora of factors, including sex steroids, genetics, epigenetics, extracellular matrix, stem cells, cardiometabolic risk factors, diet, vitamin D, and the immune system. The role of inflammation in these disorders is not limited to local pathobiology but also extends to involve clinical sequelae that range from those confined to the reproductive tract, such as infertility and gynecologic malignancies, to systemic complications such as cardiovascular disease. Enhanced understanding of the intricate mechanisms of this association will introduce us to unvisited pathophysiological perspectives and guide future diagnostic and therapeutic implications aimed at reducing the burden of these disorders. Utilization of inflammatory markers, microRNA, and molecular imaging as diagnostic adjuncts may be valuable, noninvasive techniques for prompt detection of benign gynecologic disorders. Further, use of novel as well as previously established therapeutics, such as immunomodulators, hormonal treatments, cardiometabolic medications, and cyclooxygenase-2 and NF-κB inhibitors, can target inflammatory pathways involved in their pathogenesis. In this comprehensive review, we aim to dissect the existing literature on the role of inflammation in benign gynecologic disorders, including the proposed underlying mechanisms and complex interactions, its contribution to clinical sequelae, and the clinical implications this role entails.
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Affiliation(s)
- Abdelrahman AlAshqar
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, USA
- Department of Obstetrics and Gynecology, Kuwait University, Kuwait City, Kuwait
| | - Lauren Reschke
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, USA
| | - Gregory W Kirschen
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, USA
| | - Mostafa A Borahay
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, USA
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9
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Vallée A, Vallée JN, Le Blanche A, Lecarpentier Y. PPARγ Agonists: Emergent Therapy in Endometriosis. Pharmaceuticals (Basel) 2021; 14:ph14060543. [PMID: 34204039 PMCID: PMC8229142 DOI: 10.3390/ph14060543] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/31/2021] [Accepted: 06/04/2021] [Indexed: 01/01/2023] Open
Abstract
Endometriosis is one of the major gynecological diseases of reproductive-age women. This disease is characterized by the presence of glands and stroma outside the uterine cavity. Several studies have shown the major role of inflammation, angiogenesis, adhesion and invasion, and apoptosis in endometriotic lesions. Nevertheless, the mechanisms underlying endometriotic mechanisms still remain unclear and therapies are not currently efficient. The introduction of new agents can be effective by improving the condition of patients. PPARγ ligands can directly modulate these pathways in endometriosis. However, data in humans remain low. Thus, the purpose of this review is to summarize the potential actions of PPARγ agonists in endometriosis by acting on inflammation, angiogenesis, invasion, adhesion, and apoptosis.
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Affiliation(s)
- Alexandre Vallée
- Department of Clinical Research and Innovation (DRCI), Foch Hospital, 92150 Suresnes, France
- Correspondence:
| | - Jean-Noël Vallée
- Centre Hospitalier Universitaire (CHU) Amiens Picardie, Université Picardie Jules Verne (UPJV), 80000 Amiens, France;
- DACTIM-Mis, Laboratoire de Mathématiques et Applications (LMA), UMR CNRS 7348, Université de Poitiers, 86000 Poitiers, France
| | - Alain Le Blanche
- Laboratoire CeRSM (EA-2931), UPL, Université Paris Nanterre, F92000 Nanterre, France;
- Hôpital René-Dubos de Pontoise and Université de Versailles-Saint-Quentin, Simone Veil UFR des Sciences de la Santé, 78180 Montigny-le-Bretonneux, France
| | - Yves Lecarpentier
- Centre de Recherche Clinique, Grand Hôpital de l’Est Francilien (GHEF), 77100 Meaux, France;
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10
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Acién P, Velasco I, Acién M. Anastrozole and levonorgrestrel-releasing intrauterine device in the treatment of endometriosis: a randomized clinical trial. BMC WOMENS HEALTH 2021; 21:211. [PMID: 34016111 PMCID: PMC8138989 DOI: 10.1186/s12905-021-01347-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 05/06/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND To study the effectiveness of an aromatase inhibitor (Anastrozole) associated with levonorgestrel-releasing intrauterine device (LNG-IUD, Mirena®) in the treatment of endometriosis. METHODS Prospective, randomized clinical trial. SETTING University Hospital (single center). Elegibility criteria: Endometriomas > 3 × 4 cm, CA-125 > 35 U/mL and endometriosis symptoms. PATIENTS Thirty-one women randomized to anastrozole + Mirena® + Conservative Surgery(CS) (n = 8), anastrozole + Mirena® + transvaginal ultrasound-guided puncture-aspiration (TUGPA) (n = 7), Mirena® + CS (n = 9), or Mirena® + TUGPA (n = 7). INTERVENTIONS Anastrozole 1 mg/day and/or only Mirena® for 6 months; CS (ovarian and fertility-sparing) or TUGPA of endometriomas one month after starting medical treatment. MAIN OUTCOME MEASURES Visual analogic scale for symptoms, CA-125 levels, ultrasound findings of endometriomas and recurrences. RESULTS A significant improvement in symptoms during the treatment (difference of 43%, 95% CI 29.9-56.2) occurred, which was maintained at 1 and 2 years. It was more significant in patients including anastrozole in their treatment (51%, 95% CI 33.3-68.7). For CA-125, the most significant decrease was observed in patients not taking anastrozole (73.8%, 95% CI 64.2-83.4 vs. 53.8%, 95% CI 25.7-81.6 under Mirena® + anastrozole). After CS for endometriosis, a reduction of ultrasound findings of endometriomas and long-term recurrence occurred, with or without anastrozole. At 4.2 ± 1.7 years (95% CI 3.57-4.85), 88% of the patients who underwent CS were asymptomatic, without medication or reoperation, compared to only 21% if TUGPA was performed, with or without anastrozole (p = 0.019). CONCLUSIONS Dosing anastrozole for 6 months, starting one month before CS of endometriosis, reduces significantly the painful symptoms and delays recurrence, but has no other significant advantages over the single insertion of LNG-IUD (Mirena®) during the same time. Anastrozole and/or only Mirena® associated with TUGPA are not effective. TRIAL REGISTRATION Eudra CT System of the European Medicines Agency (London, 29-Sept-2008) Nº EudraCT: 2008-005744-17 (07/11/2008). Date of enrolment of first patient: 15/01/2009.
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Affiliation(s)
- Pedro Acién
- Department/Division of Gynecology, Miguel Hernández University, San Juan Campus, 03550, San Juan, Alicante, Spain. .,Obstetrics and Gynecology Service, San Juan University Hospital, 03550, San Juan, Alicante, Spain. .,Departamento/Area de Ginecología, Facultad de Medicina de La Universidad "Miguel Hernández", Campus de San Juan, 03550, Alicante, Spain.
| | - Irene Velasco
- Obstetrics and Gynecology Service, San Juan University Hospital, 03550, San Juan, Alicante, Spain
| | - Maribel Acién
- Department/Division of Gynecology, Miguel Hernández University, San Juan Campus, 03550, San Juan, Alicante, Spain.,Obstetrics and Gynecology Service, San Juan University Hospital, 03550, San Juan, Alicante, Spain
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11
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Estes SJ, Huisingh CE, Chiuve SE, Petruski-Ivleva N, Missmer SA. Depression, Anxiety, and Self-Directed Violence in Women With Endometriosis: A Retrospective Matched-Cohort Study. Am J Epidemiol 2021; 190:843-852. [PMID: 33184648 PMCID: PMC8247611 DOI: 10.1093/aje/kwaa249] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 11/04/2020] [Accepted: 11/04/2020] [Indexed: 12/19/2022] Open
Abstract
The purpose of this study was to compare the incidence of mental health outcomes in women in the United States with and without documented endometriosis. In a retrospective matched-cohort study using administrative health claims data from Optum's Clinformatics DataMart from May 1, 2000, through March 31, 2019, women aged 18-50 years with endometriosis (n = 72,677), identified by International Classification of Disease diagnosis codes (revisions 9 or 10), were matched 1:2 on age and calendar time to women without endometriosis (n = 147,251), with a median follow-up of 529 days (interquartile range, 195, 1,164). The rate per 1,000 person-years of anxiety, depression, and self-directed violence among women with endometriosis was 57.1, 47.7, and 0.9, respectively. Comparing women with endometriosis to those without, the adjusted hazard ratios and 95% confidence intervals were 1.38 (1.34, 1.42) for anxiety, 1.48 (1.44, 1.53) for depression, and 2.03 (1.60, 2.58) for self-directed violence. The association with depression was stronger among women younger than 35 years (P for heterogeneity < 0.01). Risk factors for incident depression, anxiety, and self-directed violence among women with endometriosis included endometriosis-related pain symptoms and prevalence of other chronic conditions associated with pain. The identification of risk factors for mental health conditions among women with endometriosis may improve patient-centered disease management.
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Affiliation(s)
| | - Carrie E Huisingh
- Correspondence to Dr. Carrie E. Huisingh, Pharmacovigilance
& Patient Safety, AbbVie, Inc., 1 North Waukegan Road, North Chicago, IL
60064 (e-mail: )
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12
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Cordaro M, Trovato Salinaro A, Siracusa R, D’Amico R, Impellizzeri D, Scuto M, Ontario ML, Interdonato L, Crea R, Fusco R, Cuzzocrea S, Di Paola R, Calabrese V. Hidrox ® and Endometriosis: Biochemical Evaluation of Oxidative Stress and Pain. Antioxidants (Basel) 2021; 10:720. [PMID: 34064310 PMCID: PMC8147870 DOI: 10.3390/antiox10050720] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/26/2021] [Accepted: 04/30/2021] [Indexed: 12/26/2022] Open
Abstract
Endometriosis is a gynecological and painful condition affecting women of reproductive age. It is characterized by dysfunctional endometrium-like implants outside of the uterine cavity. The purpose of this study was to evaluate the effects of Hidrox®, an aqueous extract of olive pulp containing hydroxytyrosol, on endometriotic lesions associated with pro-oxidative alterations and pain-like behaviors. Endometriosis was induced by intraperitoneal injection of uterine fragments, and Hidrox® was administered daily. At the end of the 14-day treatment, behavioral alterations were assessed and hippocampal tissues were collected. Laparotomy was performed, and the endometrial implants were harvested for histological and biochemical analysis. Hidrox® treatment reduced endometriotic implant area, diameter and volumes. Vehicle-treated rats showed lesional fibrosis, epithelial-mesenchymal transition and fibroblast-myofibroblast transdifferentiation, angiogenesis and pro-oxidative alterations in the peritoneal cavity. Hidrox® treatment reduced the aniline blue-stained area, α-smooth muscle actin (α-sma) and CD34 positive expressions. Moreover, it reduced mast cell recruitment into the lesions, myeloperoxidase activity and lipid peroxidation and increased superoxide dismutase (SOD) activity and glutathione levels in the endometrial explants. In the peritoneal fluid, Hidrox® treatment reduced interleukin (IL)-1β, IL2, IL6, tumor necrosis factor-α (TNF-α) and vascular endothelial grow factor (VEGF) levels increased by the disease. Hidrox® administration also reduced peripheral and visceral sensibility as shown by the behavioral tests (open field test, hot plate test, elevated plus maze test and acetic-acid-induced abdominal contractions). Animals treated with Hidrox® also showed reduced blood-brain barrier permeability and mast cell infiltration in the hippocampus, as well as astrocyte and microglia activation and brain oxidative status restoring brain-derived neurotrophic factor (BDNF) protein expression and increasing Nuclear factor erythroid 2-related factor 2 (Nfr2) nuclear translocation. In conclusion, Hidrox® displayed potential ameliorative effects on endometriotic implants and related pain-induced behaviors due to its potent antioxidative properties.
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Affiliation(s)
- Marika Cordaro
- Department of Biomedical, Dental and Morphological and Functional Imaging University of Messina, Via Consolare Valeria, 98125 Messina, Italy; (M.C.); (R.D.P.); (V.C.)
| | - Angela Trovato Salinaro
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95124 Catania, Italy; (A.T.S.); (M.S.); (M.L.O.)
| | - Rosalba Siracusa
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy; (R.S.); (R.D.); (D.I.); (L.I.)
| | - Ramona D’Amico
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy; (R.S.); (R.D.); (D.I.); (L.I.)
| | - Daniela Impellizzeri
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy; (R.S.); (R.D.); (D.I.); (L.I.)
| | - Maria Scuto
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95124 Catania, Italy; (A.T.S.); (M.S.); (M.L.O.)
| | - Maria Laura Ontario
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95124 Catania, Italy; (A.T.S.); (M.S.); (M.L.O.)
| | - Livia Interdonato
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy; (R.S.); (R.D.); (D.I.); (L.I.)
| | - Roberto Crea
- Oliphenol LLC., 26225 Eden Landing Road, Unit C, Hayward, CA 94545, USA;
| | - Roberta Fusco
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy; (R.S.); (R.D.); (D.I.); (L.I.)
| | - Salvatore Cuzzocrea
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy; (R.S.); (R.D.); (D.I.); (L.I.)
| | - Rosanna Di Paola
- Department of Biomedical, Dental and Morphological and Functional Imaging University of Messina, Via Consolare Valeria, 98125 Messina, Italy; (M.C.); (R.D.P.); (V.C.)
| | - Vittorio Calabrese
- Department of Biomedical, Dental and Morphological and Functional Imaging University of Messina, Via Consolare Valeria, 98125 Messina, Italy; (M.C.); (R.D.P.); (V.C.)
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13
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Lopez A, Cruz ML, Chompre G, Hernández S, Isidro RA, Flores I, Appleyard CB. Influence of Stress on the Vitamin D-Vitamin D Receptor System, Macrophages, and the Local Inflammatory Milieu in Endometriosis. Reprod Sci 2020; 27:2175-2186. [PMID: 32583376 DOI: 10.1007/s43032-020-00235-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/01/2020] [Accepted: 06/08/2020] [Indexed: 11/27/2022]
Abstract
We previously demonstrated the negative impact of stress in an animal model of endometriosis. Although its role is unclear, altered levels of vitamin D (VitD) have been found in patients with this condition. VitD signaling through the VitD receptor (VDR) has anti-proliferative properties and induces an anti-inflammatory phenotype in macrophages. We hypothesized that stress impacts the vitamin D-VDR system, influencing macrophage behavior and the local inflammatory milieu in endometriosis. Endometriosis was surgically induced in female Sprague-Dawley rats, which were then exposed to uncontrollable, controllable, or no stress for 10 days. Sham controls received sutures only. VitD levels were measured by ELISA; cytokine levels by multiplex assay and PCR; and VDR expression and macrophage numbers assessed by immunohistochemistry and immunofluorescence. VDR expression in patient samples was assessed by immunohistochemical staining of a tissue microarray. Serum VitD levels were higher in endometriosis animals compared with sham (p < 0.01) with no significant effect of stress. Uncontrollable stress increased macrophage infiltration (p < 0.01) and VDR expression in vesicles, which were attenuated by controllable stress. Macrophage infiltration correlated with vesicle area (p < 0.05), and peritoneal vitamin D levels correlated with vesicle VDR expression (r = 0.81, p < 0.01). Decreased expression of chemokine ligand 2 (p < 0.05) and TGFβ was observed in endometriosis with uncontrollable stress, whereas IL12 increased with controllable stress. Differential expression of VDR was observed in patient tissues. Stress exacerbates development of cysts in endometriosis through mechanisms that include macrophage recruitment, cytokine changes, and a potentially perturbed VitD:VDR axis, suggesting an impact on the local inflammatory environment.
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Affiliation(s)
- Abdon Lopez
- Department of Biology, University of Puerto Rico, Ponce Campus, Ponce, PR, USA
| | - Myrella L Cruz
- Department of Basic Sciences, Physiology Division, Ponce Health Sciences University-Medical School and Ponce Research Institute, 395 Zona Ind Reparada 2, Ponce, PR, 00716-2347, USA
| | - Gladys Chompre
- Biology and Biotechnology Department, Pontifical Catholic University of Puerto Rico, Ponce Campus, Ponce, PR, 00732, USA
| | - Siomara Hernández
- Department of Basic Sciences, Physiology Division, Ponce Health Sciences University-Medical School and Ponce Research Institute, 395 Zona Ind Reparada 2, Ponce, PR, 00716-2347, USA
| | - Raymond A Isidro
- Department of Basic Sciences, Physiology Division, Ponce Health Sciences University-Medical School and Ponce Research Institute, 395 Zona Ind Reparada 2, Ponce, PR, 00716-2347, USA
| | - Idhaliz Flores
- Department of Basic Sciences, Physiology Division, Ponce Health Sciences University-Medical School and Ponce Research Institute, 395 Zona Ind Reparada 2, Ponce, PR, 00716-2347, USA
| | - Caroline B Appleyard
- Department of Basic Sciences, Physiology Division, Ponce Health Sciences University-Medical School and Ponce Research Institute, 395 Zona Ind Reparada 2, Ponce, PR, 00716-2347, USA.
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14
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Pathophysiological Basis of Endometriosis-Linked Stress Associated with Pain and Infertility: A Conceptual Review. REPRODUCTIVE MEDICINE 2020. [DOI: 10.3390/reprodmed1010004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Women with endometriosis are often under stress due to the associated pain, infertility, inflammation-related and other comorbidities including cancer. Additionally, these women are also under stress due to taboos, myths, inter-personal troubles surrounding infertility and pain of the disease as well as due to frequent incidences of missed diagnosis and treatment recurrence. Often these women suffer from frustration and loss of valuable time in the prime phase of life. All these complexities integral to endometriosis posit a hyperstructure of integrative stress physiology with overt differentials in effective allostatic state in women with disease compared with disease-free women. In the present review, we aim to critically examine various aspects of pathophysiological basis of stress surrounding endometriosis with special emphasis on pain and subfertility that are known to affect the overall health and quality of life of women with the disease and promising pathophysiological basis for its effective management.
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15
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Vallée A, Lecarpentier Y. Curcumin and Endometriosis. Int J Mol Sci 2020; 21:E2440. [PMID: 32244563 PMCID: PMC7177778 DOI: 10.3390/ijms21072440] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 03/17/2020] [Accepted: 03/23/2020] [Indexed: 12/14/2022] Open
Abstract
Endometriosis is one of the main common gynecological disorders, which is characterized by the presence of glands and stroma outside the uterine cavity. Some findings have highlighted the main role of inflammation in endometriosis by acting on proliferation, apoptosis and angiogenesis. Oxidative stress, an imbalance between reactive oxygen species and antioxidants, could have a key role in the initiation and progression of endometriosis by resulting in inflammatory responses in the peritoneal cavity. Nevertheless, the mechanisms underlying this disease are still unclear and therapies are not currently efficient. Curcumin is a major anti-inflammatory agent. Several findings have highlighted the anti-oxidant, anti-inflammatory and anti-angiogenic properties of curcumin. The purpose of this review is to summarize the potential action of curcumin in endometriosis by acting on inflammation, oxidative stress, invasion and adhesion, apoptosis and angiogenesis.
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Affiliation(s)
- Alexandre Vallée
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, AP-HP, Paris-Descartes University, 75004 Paris, France
| | - Yves Lecarpentier
- Centre de Recherche Clinique, Grand Hôpital de l’Est Francilien (GHEF), 77100 Meaux, France;
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16
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Chou YC, Chen CH, Chen MJ, Chang CW, Chen PH, Yu MH, Chen YJ, Tsai EM, Yang PS, Lin SY, Tzeng CR. Killer cell immunoglobulin-like receptors (KIR) and human leukocyte antigen-C (HLA-C) allorecognition patterns in women with endometriosis. Sci Rep 2020; 10:4897. [PMID: 32184413 PMCID: PMC7078270 DOI: 10.1038/s41598-020-61702-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 02/24/2020] [Indexed: 12/22/2022] Open
Abstract
Endometriosis shares similarities with several autoimmune diseases. The human leukocyte antigen (HLA)-C genotype is associated with several human autoimmune diseases. HLA-C is a ligand of killer cell immunoglobulin receptors (KIRs) and is an essential regulator of natural killer cell activity, which is associated with endometriosis progression. Polymorphisms in HLA-C and KIR affect the activity of NK cells and susceptibility to several diseases. Therefore, we attempted to investigate an association between HLA-C genotype and KIR polymorphism and the occurrence of endometriosis. We tested the association of certain KIR and HLA-C combinations and the development of endometriosis by characterizing both KIR and HLA-C genes in 147 women with endometriosis and 117 controls. The HLA-C genotypes and KIR polymorphisms were analyzed via DNA-based method for higher-resolution genotyping. We found that the occurrence of HLA-C*03:03*01 was increased in endometriosis than in control groups. Analysis of various KIR haplotypes revealed differences between the endometriosis and control cohorts. The number of KIR centromeric A/A haplotypes was increased in the endometriosis group than controls. Moreover, the endometriosis cohort was characterized by reduced number of KIR2DS2-positive individuals in the Han Chinese population. Our current findings suggest that the KIR and HLA-C genotypes are associated with the pathogenesis of endometriosis.
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Affiliation(s)
- Ya-Ching Chou
- Center for Reproductive Medicine & Sciences, Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan.,Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Biological Science and Technology, College of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan.,Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), National Chiao Tung University, Hsinchu, Taiwan
| | - Chi-Huang Chen
- Center for Reproductive Medicine & Sciences, Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan.,Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ming-Jer Chen
- Department of Obstetrics and Gynecology and Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ching-Wen Chang
- Center for Reproductive Medicine & Sciences, Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Pi-Hua Chen
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Obstetrics and Gynecology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Mu-Hsien Yu
- Department of Obstetrics & Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Jen Chen
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Eing-Mei Tsai
- General Research Centers of R&D office, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Peng-Sheng Yang
- Center for Reproductive Medicine & Sciences, Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Shyr-Yeu Lin
- Center for Reproductive Medicine & Sciences, Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan.,Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chii-Ruey Tzeng
- Center for Reproductive Medicine & Sciences, Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan. .,Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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17
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Reis FM, Coutinho LM, Vannuccini S, Luisi S, Petraglia F. Is Stress a Cause or a Consequence of Endometriosis? Reprod Sci 2020; 27:39-45. [PMID: 32046437 DOI: 10.1007/s43032-019-00053-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 06/05/2019] [Indexed: 12/18/2022]
Abstract
Clinical studies clearly indicate that endometriosis is a condition associated with high levels of chronic stress. The stress intensity correlates with pain severity and disease extension. However, it is unknown whether chronic stress represents a primary cause of endometriosis and, therefore, if avoiding or treating chronic stress may reduce the risk of developing endometriosis. Repeated, uncontrolled stress either before or after experimental endometriosis induction promotes disease mechanisms and accelerates lesion growth in rodents. Furthermore, patients with endometriosis have a heightened risk of other inflammatory and immune-related diseases, many of which have also been associated with stress. Here, we review the latest evidences regarding the relationship between chronic stress and endometriosis and discuss the potential bidirectional aspect of such association. Further research may clarify if endometriosis is a cause and/or a consequence of stress and whether stress-reducing therapies are effective to mitigate symptoms and slow down the development of endometriotic lesions.
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Affiliation(s)
- Fernando M Reis
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Larissa M Coutinho
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Department of Maternal and Child Health, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - Silvia Vannuccini
- Department of Neuroscience, Psychology, Pharmacology and Child Health (NEUROFARBA), University of Florence, Careggi University Hospital, Largo G. Alessandro Brambilla, 3, 50134, Florence, FI, Italy.,Department of Molecular and Developmental Medicine, Obstetrics and Gynecology, University Hospital of Siena, Siena, Italy
| | - Stefano Luisi
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecology, University Hospital of Siena, Siena, Italy
| | - Felice Petraglia
- Department of Experimental, Clinical and Biomedical Sciences, Obstetrics and Gynecology, University of Florence, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.
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18
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De Franciscis P, Colacurci N, Riemma G, Conte A, Pittana E, Guida M, Schiattarella A. A Nutraceutical Approach to Menopausal Complaints. ACTA ACUST UNITED AC 2019; 55:medicina55090544. [PMID: 31466381 PMCID: PMC6780855 DOI: 10.3390/medicina55090544] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/22/2019] [Accepted: 08/24/2019] [Indexed: 12/21/2022]
Abstract
The menopausal transition, or perimenopause, is characterized by menstrual irregularities, vasomotor symptoms, sleep disturbances, mood symptoms, and urogenital tract atrophy. These changes can also affect the quality of life and one’s self-esteem. Hormone replacement therapy (HRT) is considered the best option to achieve therapeutic relief of different menopausal symptoms but is usually restricted to moderate or severe symptoms. Moreover, many women refuse HRT for a variety of reasons concerning the fear of cancer and other adverse effects. According to these considerations, new topics are emerging: Dissatisfaction with drug costs and conventional healthcare, desire for personalized medicines, and the public perception that “natural is good”. In this context, nonhormonal therapies are mostly evolving, and it is not unusual that women often request a “natural” approach for their symptoms. The aim of this study is to investigate nonhormonal therapies that have been identified to reduce the menopausal symptoms.
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Affiliation(s)
- Pasquale De Franciscis
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Nicola Colacurci
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Gaetano Riemma
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Anna Conte
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Erika Pittana
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Maurizio Guida
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples "Federico II", 80138 Naples, Italy
| | - Antonio Schiattarella
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.
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Endometriosis and ovarian cancer: Their association and relationship. Eur J Obstet Gynecol Reprod Biol X 2019; 3:100053. [PMID: 31404281 PMCID: PMC6687431 DOI: 10.1016/j.eurox.2019.100053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/17/2019] [Accepted: 05/18/2019] [Indexed: 02/07/2023] Open
Abstract
Objectives To study endometriosis-associated borderline or malignant ovarian epithelial tumors by analyzing their differential clinical features, as well as the histological pattern, survival and immunohistochemical data compared with those without associated endometriosis. Study design Setting: Hospital Marina Baixa and San Juan University Hospital, Alicante, Spain. This retrospective study included clinical and pathological data from 36 operated cases with endometriosis-associated ovarian epithelial tumors and 305 cases of ovarian epithelial tumors without endometriosis, including borderline and invasive tumors. We also studied hormonal receptors and p53 protein expression in 13 cases with endometriosis-associated endometrioid and clear cell tumors, and report two cases with histologically-confirmed previous endometriosis. Results Associated endometriosis was observed in 10.5% of patients with borderline or invasive ovarian epithelial tumor, 53% of those with endometrioid, and 22% with clear cell tumors. Patients with endometriosis-associated ovarian epithelial tumors were younger, had lower parity, were more frequently premenopausal, had a lower tumor stage or were borderline, and in general had better prognosis and longer survival, although they also more frequently had an associated endometrial carcinoma. Associated endometriosis and endometrioid tumors were generally estrogen-receptor positive, whereas they were negative in the clear cell tumor component. p53 protein positivity was generally observed in clear cell tumors and in associated endometriosis. Two reported cases with previous, known endometriosis were followed in their evolution to borderline endometrioid carcinoma and clear cell carcinoma, respectively. Conclusions Our results and review of the literature suggest that the association of ovarian epithelial tumors and endometriosis is a factor for good prognosis for ovarian cancer and that this association might correspond in many cases to an intermediate stage in the development of endometriosis to endometrioid, clear cell, or other invasive carcinomas.
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20
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Boneva RS, Lin JMS, Wieser F, Nater UM, Ditzen B, Taylor RN, Unger ER. Endometriosis as a Comorbid Condition in Chronic Fatigue Syndrome (CFS): Secondary Analysis of Data From a CFS Case-Control Study. Front Pediatr 2019; 7:195. [PMID: 31179251 PMCID: PMC6537603 DOI: 10.3389/fped.2019.00195] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 04/25/2019] [Indexed: 12/21/2022] Open
Abstract
Background: Endometriosis (EM) is a recognized co-morbid condition in women with chronic fatigue syndrome (CFS). This analysis evaluates the impact of EM on the health of women with CFS by comparing selected health characteristics and laboratory parameters in women with CFS with and without EM (CFS+EM and CFS-only). Methods: This secondary analysis included all 36 women with CFS from a cross-sectional study of CFS in Wichita, KS, conducted between 2002 and 2003. The health characteristics and laboratory parameters of interest included functioning, fatigue, CFS-related symptoms, gynecologic history, routine laboratory parameters, inflammatory markers, cortisol levels, allostatic load, and sleep parameters (overnight polysomnography). We used parametric or non-parametric tests to compare group differences in the selected health characteristics and laboratory parameters. For examining the association between EM and variables of interest, logistic regression models were performed and odds ratios (OR) with 95% confidence intervals (CI) were reported for the magnitude of associations. Statistical significance was set at 0.05 (two-sided). Results: The mean age of this study sample was 50.9 years. Of women with CFS, 36.1% reported having EM. Age and body mass index (BMI) did not differ between CFS+EM and CFS-only groups. When examining the impact of EM, compared to women with CFS-only, women with both CFS and EM were more likely to report chronic pelvic pain [OR = 9.00 (95% CI, 1.47-55.25)] and hysterectomy [OR = 10.3 (1.82-58.39)], had more CFS symptoms (6.8 ± 0.3 vs. 5.5 ± 0.3, p = 0.02), younger mean age at menopause onset (36.4 ± 3.0 vs. 47.0 ± 2.7 years, p = 0.03), higher mean number of obstructive apnea episodes per hour (20.3 vs. 4.4, p = 0.05) and reported more negative life events (15.8 vs. 4.4, p = 0.05). Other parameters did not differ significantly between the two groups. Conclusions: We found more than a third of women with CFS reported endometriosis as a comorbid condition. The endometriosis comorbidity was associated with chronic pelvic pain, earlier menopause, hysterectomy, and more CFS-related symptoms. However, endometriosis in women with CFS did not appear to further impact functioning, fatigue, inflammatory markers, or other laboratory parameters. Further investigations including younger women are warranted.
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Affiliation(s)
- Roumiana S. Boneva
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Jin-Mann S. Lin
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Friedrich Wieser
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Urs M. Nater
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Beate Ditzen
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Robert N. Taylor
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Elizabeth R. Unger
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
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21
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Pro-endometriotic niche in endometriosis. Reprod Biomed Online 2019; 38:549-559. [DOI: 10.1016/j.rbmo.2018.12.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/31/2018] [Accepted: 12/11/2018] [Indexed: 12/11/2022]
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22
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Barrera Villa Zevallos H, Markham R, Manconi F. The nervous system and genomics in endometriosis. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2018. [DOI: 10.1177/2284026518813487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Endometriosis is a gynaecological disease that occurs in approximately 10% to 15% of women of reproductive age and up to 47% of infertile women. The presence of implants of endometrial-like glands and stroma outside the uterus, characteristic of this disease, induce a wide variety of symptoms, mainly pelvic pain and infertility. Women suffering from this condition experience great distress, which significantly affects their quality of life. Numerous studies attempting to decipher the pathogenic mechanisms of endometriosis have been conducted around the world, yet its aetiology still remains unknown. It is widely believed that in women with endometriosis, the endometrium has characteristic features that allow the formation of implants once fragments have entered the peritoneal cavity through retrograde menstruation. Furthermore, a strong genetic tendency to develop the disease has been reported among patients and first-degree relatives. Thanks to the recent technological advances achieved in genomics and bioinformatics, a number of studies have had the potential to analyse several aspects of the pathogenesis of endometriosis from a genetic perspective. Due to the recent identification of nerve fibres in the endometrium of women with endometriosis, research on the neurogenesis of the disease has increased in the past few years. However, the genetic aspects of nerve growth in endometriosis have not been analysed in depth and further research providing important insights into the mechanisms that mediate pain in affected patients has the potential to contribute substantially to the future management of the condition.
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Affiliation(s)
| | - Robert Markham
- Discipline of Obstetrics, Gynaecology and Neonatology, The University of Sydney, Sydney, NSW, Australia
| | - Frank Manconi
- Discipline of Obstetrics, Gynaecology and Neonatology, The University of Sydney, Sydney, NSW, Australia
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23
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Manconi F, Fazleabas AT, Markham R, Fraser IS. Nerve fibre infiltration and expression in peritoneal lesions of endometriosis in a nonhuman primate model of endometriosis. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2018. [DOI: 10.1177/2284026518810594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Baboon ( Papio anubis) models of endometriosis are thought to mimic the early stages of spontaneous human peritoneal endometriotic disease. The objective of this study was to investigate the presence and course of nerve fibre ingrowth during peritoneal lesion formation in specimens collected at 3 months (early stage of lesion development) and 15 months (late stage of lesion development) after disease initiation compared to pelvic peritoneum (control). Five-micron sections of paraffin-embedded peritoneal lesions were obtained from normally cycling baboons with 3-month (n = 12), 15-month (n = 12) induced endometriosis and pelvic peritoneum (n = 10) from baboons with no endometriosis. Immunohistochemical staining was performed with specific antibodies: protein gene product 9.5 – broad marker of nerve fibres and neurones, neuropeptide Y – sympathetic neurones, substance P – sensory neurones, vasoactive intestinal peptide – parasympathetic neurones, nerve growth factor – development of new neurones and high-affinity receptor for nerve growth factor (tropomyosin receptor kinase A) – neuronal differential. Significantly, more nerve fibres were identified in peritoneal endometriotic lesions collected 15 months after the initiation of experimental protocols compared with 3-month and control samples (p < 0.001). Nerve fibres were immunoreactive for all the tested markers – protein gene product 9.5, neuropeptide Y, substance P, vasoactive intestinal peptide, nerve growth factor and tropomyosin receptor kinase A – indicating the presence of different types of nerve fibres. In conclusion, peritoneal lesions of endometriosis in a nonhuman primate model of endometriosis were found to be progressively and spontaneously innervated by both myelinated and unmyelinated sensory nerve fibres, parasympathetic and sympathetic neurones. These nerve fibres may play an important role in the mechanisms of pain generation in this condition.
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Affiliation(s)
- Frank Manconi
- Queen Elizabeth II Research Institute for Mothers and Infants, Department of Obstetrics, Gynaecology and Neonatology, The University of Sydney, Camperdown, NSW, Australia
| | - Asgi T Fazleabas
- Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Robert Markham
- Queen Elizabeth II Research Institute for Mothers and Infants, Department of Obstetrics, Gynaecology and Neonatology, The University of Sydney, Camperdown, NSW, Australia
| | - Ian S Fraser
- School of Women’s and Children’s Health and Royal Hospital for Women, University of New South Wales, Randwick, NSW, Australia
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24
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Torres-Reverón A, Rivera-Lopez LL, Flores I, Appleyard CB. Antagonizing the corticotropin releasing hormone receptor 1 with antalarmin reduces the progression of endometriosis. PLoS One 2018; 13:e0197698. [PMID: 30427841 PMCID: PMC6235236 DOI: 10.1371/journal.pone.0197698] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 10/12/2018] [Indexed: 12/12/2022] Open
Abstract
Endometriosis is a disorder in which endometrial tissue is found outside the uterus causing pain, infertility and stress. Finding effective, non-hormonal and long-term treatments for endometriosis still remains one of the most significant challenges in the field. Corticotropin releasing hormone (CRH) is one of the main signaling peptides within the hypothalamic pituitary adrenal (HPA) axis released in response to stress. CRH can affect nervous and visceral tissues such as the uterus and gut via activation of two types of CRH receptors: CRHR1 and CRHR2. Our aim was to determine if blocking CRHR1 with antalarmin will reduce endometriosis progression. In experiment 1 we induced endometriosis in female rats by suturing uterine horn tissue next to the intestinal mesentery and allowed to progress for 7 days. We determined that after 7 days, there was a significant increase in CRHR1 within endometriotic vesicles as compared to normal uterus. In Experiment 2, we induced endometriosis and administered either antalarmin (20 mg/kg, i.p.) or vehicle during the first 7 days after surgery. A separate group of sham surgery rats served as non-endometriosis controls. Endometriosis was allowed to progress until 60 days after surgery, at which time rats were tested for anxiety behaviors. At the time of sacrifice, endometriotic vesicles, uterus and blood were collected. Treatment with antalarmin significantly reduced the size (67% decrease) and number (30% decrease) of endometriotic vesicles. Antalarmin also prevented the increase in CRH and CRHR1 mRNA within endometriotic vesicles but not of glucocorticoid receptor. Endometriosis did not change anxiety behaviors in the open field and zero-maze tests and prior antalarmin administration did not modify this. Our data provides the first in-vivo demonstration for use of CRHR1 antagonist for the treatment of endometriosis opening the possibility for further exploring CRH signaling as a treatment target for this debilitating disease.
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Affiliation(s)
- Annelyn Torres-Reverón
- Dept. Neuroscience, University of Texas at Rio Grande Valley School of Medicine, Edinburg, Texas, United States of America
- Dept. of Human Genetics, University of Texas at Rio Grande Valley School of Medicine, Edinburg, Texas, United States of America
- * E-mail:
| | - Leslie L. Rivera-Lopez
- Dept. of Psychiatry and Neurology, University of Texas at Rio Grande Valley School of Medicine, Harlingen, Texas, United States of America
| | - Idhaliz Flores
- Division of Basic Sciences, Ponce Health Sciences University—Ponce Research Institute, Ponce, Puerto Rico
- Dept. of Obstetrics and Gynecology, Ponce Health Sciences University, School of Medicine, Ponce, Puerto Rico
| | - Caroline B. Appleyard
- Division of Basic Sciences, Ponce Health Sciences University—Ponce Research Institute, Ponce, Puerto Rico
- Dept. of Internal Medicine, Ponce Health Sciences University, School of Medicine, Ponce Puerto Rico
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25
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Wang D, Jiang Y, Yang X, Wei Q, Wang H. 6-Shogaol reduces progression of experimental endometriosis in vivo and in vitro via regulation of VGEF and inhibition of COX-2 and PGE2-mediated inflammatory responses. THE KOREAN JOURNAL OF PHYSIOLOGY & PHARMACOLOGY : OFFICIAL JOURNAL OF THE KOREAN PHYSIOLOGICAL SOCIETY AND THE KOREAN SOCIETY OF PHARMACOLOGY 2018; 22:627-636. [PMID: 30402023 PMCID: PMC6205945 DOI: 10.4196/kjpp.2018.22.6.627] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 02/18/2018] [Accepted: 02/27/2018] [Indexed: 12/13/2022]
Abstract
Endometriosis (EM) is one of the most common gynaecological disorder affecting women in their reproductive age. Mechanisms involved in the pathogenesis of EM remains poorly understood, however inflammatory responses have been reported to be significantly involved. The efficacy of 6-shogaol on proliferation of endometriotic lesions and inflammatory pathways in experimentally-induced EM model was explored in this study. EM was stimulated in Sprague-Dawley rats by implantation of autologous endometrium onto the peritoneum abdominal wall. Separate groups were treated with 6-shogaol (50, 100 or 150 mg/kg b.wt/day) via oral gavage for one month period. Gestrinone (GTN) group received GTN (0.5 mg/kg/day) as positive control. Five weeks after implantation, the spherical volume of ecto-uterine tissues was determined. Treatment with 6-shogaol significantly reduced the implant size. Histological analysis reported atrophy and regression of the lesions. 6-shogaol administration effectively down-regulated NF-κB signaling, VEGF and VEGFR-2 (Flk-1) expression in the endometriotic lesions. Excess production of IL-1β and IL-6 (pro-inflammatory cytokines), PGE2 and nitric oxide (NO) were reduced. Overall, the results of the study reveal the efficacy of 6-shogaol against endometriosis via effectively suppressing proliferation of the lesions and modulating angiogenesis and COX-2/NF-κB-mediated inflammatory cascades.
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Affiliation(s)
- Dan Wang
- Department of Obstetrics and Gynecology, Tongren Hospital of WuHan University (Wuhan Third Hospital), Wuhan 430074, China
| | - Yiling Jiang
- Department of Obstetrics and Gynecology, Hubei Provincial Hospital of Integrated Chinese and Western Medicine, Wuhan 430015, China
| | - Xiaoxin Yang
- Department of Obstetrics and Gynecology, Tongren Hospital of WuHan University (Wuhan Third Hospital), Wuhan 430074, China
| | - Qiong Wei
- Department of Obstetrics and Gynecology, Tongren Hospital of WuHan University (Wuhan Third Hospital), Wuhan 430074, China
| | - Huimin Wang
- Department of Obstetrics and Gynecology, Tongren Hospital of WuHan University (Wuhan Third Hospital), Wuhan 430074, China
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Márki G, Bokor A, Rigó J, Rigó A. Physical pain and emotion regulation as the main predictive factors of health-related quality of life in women living with endometriosis. Hum Reprod 2018; 32:1432-1438. [PMID: 28482063 DOI: 10.1093/humrep/dex091] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 04/20/2017] [Indexed: 12/15/2022] Open
Abstract
STUDY QUESTION To what extent are pain symptoms, psychological variables (anxiety, depression and distress) and emotion regulation associated with women's health in endometriosis? SUMMARY ANSWER Physical pain symptoms and emotion regulation difficulties via psychological stress negatively affect the health-related quality of life (HRQoL) of women living with endometriosis. WHAT IS KNOWN ALREADY There are some missing links in the definitive treatment and recovery from endometriosis. Women with chronic pain report a decrease in HRQoL and an increase in the frequency of psychological problems, but little is known about the complex relationship between these variables in the context of endometriosis. STUDY DESIGN, SIZE, DURATION This cross-sectional study was conducted between October 2014 and October 2015 on 193 women living with endometriosis. PARTICIPANTS/MATERIALS, SETTING, METHODS The sample consisted of women with a medically confirmed diagnosis of endometriosis who received treatment at the participating clinic. All participants completed the Short Form Health Survey (SF-36), the Hospital Anxiety and Depression Scale, the Perceived Stress Scale and the Difficulties in Emotion Regulation Scale. Spearman's rank correlation was used to explore the associations between the measured variables, and structural equation modeling was used to test the proposed mediation models. MAIN RESULTS AND THE ROLE OF CHANCE The response rate was 46%. In this study, 54.79% of the participants presented with anxiety and 20.3% with depressive symptoms. Pain symptoms, psychological variables and difficulties in emotion regulation were negatively associated with HRQoL. Mediation models revealed that physical pain, psychological stress and difficulties in emotion regulation explained 55% of the variance in the overall HRQoL, 41% of the variation in physical and 55% of the variation in mental HRQoL. Accordingly, severe physical pain (β = -0.39, P < 0.001) was directly, and difficulties in emotion regulation (β = -0.38, P < 0.001) was indirectly related to deterioration in overall HRQoL. Physical pain had a higher direct standardized effect (β = -0.51, P < 0.001) on physical HRQoL, and had no significant direct effect on mental HRQoL. Furthermore, both physical pain (β = -0.07, P < 0.001) and difficulties in emotion regulation (β = -0.46, P < 0.001) had a significant indirect effect on mental HRQoL. LIMITATIONS, REASONS FOR CAUTION The data were heterogeneous with regard to the severity of endometriosis. The validity of this cross-sectional study is limited to correlations; therefore, further longitudinal studies using a more representative sample are needed to explore valid causal relationships. WIDER IMPLICATIONS OF THE FINDINGS The results of this study indicate that HRQoL can be improved through pain management and emotion regulation strategies. The authors believe that HRQoL would increase with concomitant application of physical treatment and psychological care. STUDY FUNDING/COMPETING INTEREST(S) There were no external funding sources for this study, and the authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- Gabriella Márki
- Doctoral School of Psychology, Eötvös Loránd University, Budapest 1064, Hungary.,Institute of Psychology, Eötvös Loránd University, Budapest 1064, Hungary
| | - Attila Bokor
- I. Department of Obstetrics and Gynecology, Semmelweis University, Budapest 1085, Hungary
| | - János Rigó
- I. Department of Obstetrics and Gynecology, Semmelweis University, Budapest 1085, Hungary
| | - Adrien Rigó
- Institute of Psychology, Eötvös Loránd University, Budapest 1064, Hungary
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27
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Silveira CGT, Rogatto SR, Podgaec S, Abrão MS. Recent Advances in Molecular Genetics of Endometriosis. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/228402650900100103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Endometriosis (MIM 131200) is a prevalent and complex gynecological disease polygenically inherited with multifactorial pathogenesis. It is increasingly recognized as a major women's health issue. Endometriosis is characterized by the presence of endometrial-like tissue in sites outside the uterus, mainly the pelvic peritoneum, ovaries and rectovaginal septum causing severe dysmenorrhoea, dyspareunia, chronic pelvic pain and subfertility. Recent advances in molecular technologies have provided many evidences about the underlying biological events that are likely to be involved in the development of endometriosis. Different chromosomal regions, genes and other molecules, such as microRNAs, have been identified as potentially involved in endometriosis pathogenesis. Moreover, genome-wide analyses of endometriosis have showed novel molecular signatures or individual genes that had not been previously associated with the disease. The goal of these studies is to provide information that might, in turn, lead to new therapies. In this review, some previous studies were updated supporting the polygenic/multifactorial inheritance and the association with malignant neoplasias. We have also emphasized the importance of identifying the causative genes and determining novel diagnostic and predictive biomarkers.
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Affiliation(s)
| | - Silvia Regina Rogatto
- Department of Research, Antonio Prudente Foundation, AC Camargo Hospital, São Paulo and Department of Urology, School of Medicine, UNESP, Botucatu, São Paulo
| | - Sérgio Podgaec
- Department of Obstetrics and Gynecology, University of São Paulo Medical School, São Paulo - Brazil
| | - Mauricio Simões Abrão
- Department of Obstetrics and Gynecology, University of São Paulo Medical School, São Paulo - Brazil
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28
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Abstract
Endometriosis, defined by the presence of endometrial tissue outside the uterine cavity, is a common condition affecting 10% of women in the reproductive age. Menstrual factors reported to increase risk include dysmenorrhea, early menarche, and shorter cycle lengths. The theory of retrograde menstruation with implantation of endometrial fragments, in conjunction with peritoneal factors to stimulate cell growth is the most widely accepted. There is a growing body of evidence that immunological factors and angiogenesis play a key role in the pathogenesis of endometriosis. In women with endometriosis, there appears to be an alteration in the function of peritoneal macrophages, natural killer cells and lymphocytes, with production of growth factors and inflammatory mediators in the peritoneal fluid. Survival, adhesion, proliferation, invasion and vascularization of endometrial tissue in abdominal cavity may be the consequence of retrograde menstruation and referred to as implantation theory.
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Affiliation(s)
- M. Larosa
- UOC di Urologia, Azienda AUSL Reggio Emilia, Distretto di Guastalla - Italy
| | - F. Facchini
- UOC di Urologia, Azienda AUSL Reggio Emilia, Distretto di Guastalla - Italy
| | - G. Pozzoli
- UOC di Urologia, Azienda AUSL Reggio Emilia, Distretto di Guastalla - Italy
| | - M. Leone
- UOC di Urologia, Azienda AUSL Reggio Emilia, Distretto di Guastalla - Italy
| | - M. Grande
- UOC di Urologia, Azienda AUSL Reggio Emilia, Distretto di Guastalla - Italy
| | - B. Monica
- UOC di Urologia, Azienda AUSL Reggio Emilia, Distretto di Guastalla - Italy
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29
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Brubel R, Bokor A, Pohl A, Schilli GK, Szereday L, Bacher-Szamuel R, Rigo J, Polgar B. Serum galectin-9 as a noninvasive biomarker for the detection of endometriosis and pelvic pain or infertility-related gynecologic disorders. Fertil Steril 2017; 108:1016-1025.e2. [PMID: 29202955 DOI: 10.1016/j.fertnstert.2017.09.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 09/05/2017] [Accepted: 09/06/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate the usefulness of soluble galectin-9 (Gal-9) in the noninvasive laboratory diagnosis of endometriosis and various gynecologic disorders. DESIGN Prospective case-control study. SETTING University medical centers. PATIENT(S) A total of 135 women of reproductive age were involved in the study, 77 endometriosis patients, 28 gynecologic controls, and 30 healthy women. INTERVENTION(S) Diagnostic laparoscopy and collection of tissue biopsies, peritoneal cells, and native peripheral blood from different case groups of gynecology patients and healthy women. MAIN OUTCOME MEASURE(S) The expression of mRNA and serum concentration of Gal-9. RESULT(S) Semiquantitative reverse transcription-polymerase chain reaction analysis and serum soluble Gal-9 ELISA were performed on three different cohorts of patients: those with endometriosis, those with benign gynecologic disorders, and healthy controls. Differences in the Gal-9 concentrations between the investigated groups and the stability of Gal-9 in the serum and diagnostic characteristics of Gal-9 ELISA were determined by statistical evaluation and receiver operating characteristic (ROC) curve analysis. Significantly elevated Gal-9 levels were found in both minimal-mild (I-II) and moderate-severe (III-IV) stages of endometriosis in comparison with healthy controls. At a cutoff of 132 pg/mL, ROC analysis revealed an excellent diagnostic value of Gal-9 ELISA in endometriosis (area under the curve = 0.973) with a sensitivity of 94% and specificity of 93.75%, indicating better diagnostic potential than that of other endometriosis biomarkers. Furthermore, various pelvic pain or infertility-associated benign gynecologic conditions were also associated with increased serum Gal-9 levels. CONCLUSION(S) Our results suggest that Gal-9 could be a promising noninvasive biomarker of endometriosis and a predictor of various infertility or pelvic pain-related gynecologic disorders.
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Affiliation(s)
- Reka Brubel
- First Department of Obstetrics and Gynaecology, Semmelweis University, Budapest, Hungary
| | - Attila Bokor
- First Department of Obstetrics and Gynaecology, Semmelweis University, Budapest, Hungary
| | - Akos Pohl
- First Department of Obstetrics and Gynaecology, Semmelweis University, Budapest, Hungary
| | - Gabriella Krisztina Schilli
- Department of Medical Microbiology and Immunology, University of Pecs, Pecs, Hungary; Janos Szentagothai Research Centre, Pecs, Hungary
| | - Laszlo Szereday
- Department of Medical Microbiology and Immunology, University of Pecs, Pecs, Hungary; Janos Szentagothai Research Centre, Pecs, Hungary
| | - Reka Bacher-Szamuel
- Department of Medical Microbiology and Immunology, University of Pecs, Pecs, Hungary; Janos Szentagothai Research Centre, Pecs, Hungary
| | - Janos Rigo
- First Department of Obstetrics and Gynaecology, Semmelweis University, Budapest, Hungary
| | - Beata Polgar
- Department of Medical Microbiology and Immunology, University of Pecs, Pecs, Hungary; Janos Szentagothai Research Centre, Pecs, Hungary.
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30
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Torres-Reverón A, Rivera LL, Flores I, Appleyard CB. Environmental Manipulations as an Effective Alternative Treatment to Reduce Endometriosis Progression. Reprod Sci 2017; 25:1336-1348. [PMID: 29137551 DOI: 10.1177/1933719117741374] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Treatments for endometriosis include pharmacological or surgical procedures that produce significant side effects. We aimed to determine how environmental enrichment (EE) could impact the progression of endometriosis using the autotransplantation rat model. Female rats were exposed to EE (endo-EE: toys and nesting materials, 4 rats per cage, larger area enclosure) or no enrichment (endo-NE: 2 rats per cage) starting on postnatal day 21. After 8 weeks, sham surgery or surgical endometriosis was induced by suturing uterine horn tissue next to the intestinal mesentery, then allowed to progress for 60 days during which EE or NE continued. At the time of killing, we measured anxiety behaviors, collected endometriotic vesicles and uterus, and processed for quantitative real-time polymerase chain reaction for corticotropin-releasing hormone (CRH), urocortin-1, CRH receptors type 1 and type 2, and glucocorticoid receptor (GR). Endometriosis did not affect anxiety-like behaviors, yet rats in enriched conditions showed lower basal anxiety behaviors than the nonenriched group. Importantly, the endo-EE group showed a 28% reduction in the number of endometriosis vesicles and the vesicles were significantly smaller compared to the endo-NE group. Endometriosis increased CRH and GR only in the vesicles of endo-NE, and this increase was dampened in the endo-EE. However, urocortin 1 was increased in the vesicles of the endo-EE group, suggesting different pathways of activation of CRH receptors in this group. Our results suggest that the use of multimodal complementary therapies that reduce stress in endometriosis could be an effective and safe treatment alternative, with minimal side effects.
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Affiliation(s)
- Annelyn Torres-Reverón
- 1 Division of Basic Sciences, Ponce Research Institute, Ponce Health Sciences University, Ponce, Puerto Rico.,2 Department of Biomedical Sciences, Division of Neuroscience, School of Medicine, University of Texas at Rio Grande Valley, Edinburg, TX, USA.,3 Department of Psychiatry and Neurology, School of Medicine, University of Texas at Rio Grande Valley, Edinburg, TX, USA
| | - Leslie L Rivera
- 2 Department of Biomedical Sciences, Division of Neuroscience, School of Medicine, University of Texas at Rio Grande Valley, Edinburg, TX, USA.,3 Department of Psychiatry and Neurology, School of Medicine, University of Texas at Rio Grande Valley, Edinburg, TX, USA
| | - Idhaliz Flores
- 1 Division of Basic Sciences, Ponce Research Institute, Ponce Health Sciences University, Ponce, Puerto Rico.,4 Department of Obstetrics and Gynecology, School of Medicine, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Caroline B Appleyard
- 1 Division of Basic Sciences, Ponce Research Institute, Ponce Health Sciences University, Ponce, Puerto Rico.,5 Department of Internal Medicine, School of Medicine, Ponce Health Sciences University, Ponce, Puerto Rico
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31
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Daraï E, Ploteau S, Ballester M, Bendifallah S. [Pathogenesis, genetics and diagnosis of endometriosis]. Presse Med 2017; 46:1156-1165. [PMID: 29150232 DOI: 10.1016/j.lpm.2017.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 09/26/2017] [Accepted: 10/03/2017] [Indexed: 12/14/2022] Open
Abstract
Endometriosis is a multifactorial pathology. Trans-tubal reflux theory remains valid. Genetic and epigenetic factors associated with immunological perturbations are involved. The role of endocrine disruptors is discussed although epidemiological studies are contradictory. Therapeutics are primarily based on hormonal treatments but better understanding of pathophysiology should allow targeted non-hormonal therapy. The clinical examination is sometimes negative, which should not eliminate the diagnosis and imposes complementary examinations as best as possible by referents.
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Affiliation(s)
- Emile Daraï
- Assistance publique-Hôpitaux de Paris, université Pierre-et-Marie-Curie (UPMC), Paris 6, hôpital Tenon, service de gynécologie-obstétrique et reproduction humaine, 75020 Paris, France; Hôpital Tenon, centre expert en endométriose (C3E), groupe de recherche clinique (GRC-6 UPMC), 75020 Paris, France; UMRS-938 Paris 6, 75012 Paris, France; Hôpital Tenon, centre de diagnostic en un jour de l'endométriose (CDJE), 75020 Paris, France.
| | - Stéphane Ploteau
- CHU de Nantes, service de gynécologie-obstétrique, 44000 Nantes, France
| | - Marcos Ballester
- Assistance publique-Hôpitaux de Paris, université Pierre-et-Marie-Curie (UPMC), Paris 6, hôpital Tenon, service de gynécologie-obstétrique et reproduction humaine, 75020 Paris, France; Hôpital Tenon, centre expert en endométriose (C3E), groupe de recherche clinique (GRC-6 UPMC), 75020 Paris, France; UMRS-938 Paris 6, 75012 Paris, France; Hôpital Tenon, centre de diagnostic en un jour de l'endométriose (CDJE), 75020 Paris, France
| | - Sofiane Bendifallah
- Assistance publique-Hôpitaux de Paris, université Pierre-et-Marie-Curie (UPMC), Paris 6, hôpital Tenon, service de gynécologie-obstétrique et reproduction humaine, 75020 Paris, France; Hôpital Tenon, centre expert en endométriose (C3E), groupe de recherche clinique (GRC-6 UPMC), 75020 Paris, France; Hôpital Tenon, centre de diagnostic en un jour de l'endométriose (CDJE), 75020 Paris, France
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32
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Arablou T, Kolahdouz-Mohammadi R. Curcumin and endometriosis: Review on potential roles and molecular mechanisms. Biomed Pharmacother 2017; 97:91-97. [PMID: 29080464 DOI: 10.1016/j.biopha.2017.10.119] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 10/13/2017] [Accepted: 10/21/2017] [Indexed: 11/26/2022] Open
Abstract
Endometriosis, an estrogen-dependent inflammatory disease, is one of the most common chronic gynecological disorders affecting women in reproductive age. It is characterized by the presence of endometrial-like tissue outside the uterus. The exact pathophysiology of endometriosis is not still well-known, but the immune system and inflammation have been considered as pivotal factors in disease progression. Turmeric, an important spice all around the world, is obtained from the rhizomes of Curcuma longa, a member of the Zingiberaceae family. It has been used in the prevention and treatment of many diseases since ancient times. Curcumin is the principal polyphenol isolated from turmeric. Several evidences have shown the anti-inflammatory, antioxidant, anti-tumor, anti-angiogenesis, and anti-metastatic activities of curcumin. In this review, relevant articles on the effect of curcumin on endometriosis and possible molecular mechanisms are discussed.
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Affiliation(s)
- Tahereh Arablou
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Roya Kolahdouz-Mohammadi
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.
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33
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Manibusan MK, Touart LW. A comprehensive review of regulatory test methods for endocrine adverse health effects. Crit Rev Toxicol 2017; 47:433-481. [PMID: 28617201 DOI: 10.1080/10408444.2016.1272095] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Development of new endocrine disruption-relevant test methods has been the subject of intensive research efforts for the past several decades, prompted in part by mandates in the 1996 Food Quality Protection Act (FQPA). While scientific understanding and test methods have advanced, questions remain on whether current scientific methods are capable of adequately addressing the complexities of the endocrine system for regulatory health and ecological risk assessments. The specific objective of this article is to perform a comprehensive, detailed evaluation of the adequacy of current test methods to inform regulatory risk assessments of whether a substance has the potential to perturb endocrine-related pathways resulting in human adverse effects. To that end, approximately 42 existing test guidelines (TGs) were considered in the evaluation of coverage for endocrine-related adverse effects. In addition to evaluations of whether test methods are adequate to capture endocrine-related effects, considerations of further enhancements to current test methods, along with the need to develop novel test methods to address existing test method gaps are described. From this specific evaluation, up to 35 test methods are capable of informing whether a chemical substance perturbs known endocrine related biological pathways. Based on these findings, it can be concluded that current validated test methods are adequate to discern substances that may perturb the endocrine system, resulting in an adverse health effect. Together, these test methods predominantly form the core data requirements of a typical food-use pesticide registration submission. It is recognized, however, that the current state of science is rapidly advancing and there is a need to update current test methods to include added enhancements to ensure continued coverage and public health and environmental protection.
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Affiliation(s)
| | - L W Touart
- b Equiparent Consulting , Woodbridge , VA , USA
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Perelló M, González-Foruria I, Castillo P, Martínez-Florensa M, Lozano F, Balasch J, Carmona F. Oral Administration of Pentoxifylline Reduces Endometriosis-Like Lesions in a Nude Mouse Model. Reprod Sci 2016; 24:911-918. [DOI: 10.1177/1933719116673198] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Maria Perelló
- Clinical Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Iñaki González-Foruria
- Clinical Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Paola Castillo
- Biomedical Diagnostic Center, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Mario Martínez-Florensa
- Group of Immunoreceptors of the Innate and Adaptive System, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Francisco Lozano
- Group of Immunoreceptors of the Innate and Adaptive System, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Immunology Service, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
- Department of Cell Biology, Immunology and Neurosciences, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Juan Balasch
- Clinical Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
- Group of Endocrinology, Gynecology and Human Reproduction, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Francisco Carmona
- Clinical Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
- Group of Endocrinology, Gynecology and Human Reproduction, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Sheveleva T, Bejenar V, Komlichenko E, Dedul A, Malushko A. Innovative approach in assessing the role of neurogenesis, angiogenesis, and lymphangiogenesis in the pathogenesis of external genital endometriosis. Gynecol Endocrinol 2016; 32:75-79. [PMID: 27759453 DOI: 10.1080/09513590.2016.1232789] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Endometriosis is a chronic, progressive, relapsing estrogen-dependent disorder characterized by the growth of tissue structure and function similar to the endometrium outside the normal mucosa of the uterine cavity localization. Endometriosis is found in 10-15% of women in reproductive age and it is one of the main causes of pelvic pain syndrome and infertility. Mechanisms of the development of endometriosis and related pathological pain impulses are still poorly understood and therapeutic approaches do not always have a sufficient effect; in this connection, the study of the pathogenesis of endometriosis and endometriosis-associated pain currently is perspective. Identification of significant factors of angiogenesis, lymphangiogenesis, and neurogenesis in the external genital endometriosis will promote the development of non-invasive early diagnosis and pathogenetic therapy.
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Affiliation(s)
| | - V Bejenar
- b Department of Obstetrics - Gynecology and Neonatology , Clinic of Obstetrics and Gynecology, St. Petersburg State Medical University Named After Academician I. P. Pavlov , Saint Petersburg , Russia
| | - E Komlichenko
- b Department of Obstetrics - Gynecology and Neonatology , Clinic of Obstetrics and Gynecology, St. Petersburg State Medical University Named After Academician I. P. Pavlov , Saint Petersburg , Russia
| | - A Dedul
- b Department of Obstetrics - Gynecology and Neonatology , Clinic of Obstetrics and Gynecology, St. Petersburg State Medical University Named After Academician I. P. Pavlov , Saint Petersburg , Russia
- c Department of Family Planning and Human Reproduction , University Hospital of Saint-Petersburg State University , Saint-Petersburg , Russia , and
| | - A Malushko
- d Department of Gynecology , University Hospital of Saint-Petersburg State University , Saint-Petersburg , Russia
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Chen P, Wang DB, Liang YM. Evaluation of estrogen in endometriosis patients: Regulation of GATA-3 in endometrial cells and effects on Th2 cytokines. J Obstet Gynaecol Res 2016; 42:669-77. [PMID: 26890586 DOI: 10.1111/jog.12957] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 12/22/2015] [Indexed: 12/12/2022]
Affiliation(s)
- Peng Chen
- Department of Obstetrics and Gynecology; Shengjing Hospital of China Medical University; Shenyan China
| | - Dan-Bo Wang
- Department of Obstetrics and Gynecology; Shengjing Hospital of China Medical University; Shenyan China
| | - Yan-Ming Liang
- Department of Obstetrics and Gynecology; Shengjing Hospital of China Medical University; Shenyan China
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Delbandi AA, Mahmoudi M, Shervin A, Zarnani AH. 1,25-Dihydroxy Vitamin D3 Modulates Endometriosis-Related Features of Human Endometriotic Stromal Cells. Am J Reprod Immunol 2015; 75:461-73. [DOI: 10.1111/aji.12463] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 11/18/2015] [Indexed: 12/22/2022] Open
Affiliation(s)
- Ali-Akbar Delbandi
- Immunology Research Center; Iran University of Medical Sciences; Tehran Iran
- Immunology Research Center; School of Medicine; Mashhad University of Medical Sciences; Mashhad Iran
| | - Mahmoud Mahmoudi
- Immunology Research Center; School of Medicine; Mashhad University of Medical Sciences; Mashhad Iran
| | - Adel Shervin
- Reproductive Biotechnology Research Center; Avicenna Research Institute; ACECR; Tehran Iran
| | - Amir-Hassan Zarnani
- Immunology Research Center; Iran University of Medical Sciences; Tehran Iran
- Reproductive Immunology Research Center; Avicenna Research Institute; ACECR; Tehran Iran
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Che XH, Chen YC, Chen CL, Ye XL, Zhu H. Non-hormonal targets underlying endometriosis: A focus on molecular mechanisms. Mol Reprod Dev 2015; 82:410-31. [PMID: 25982890 DOI: 10.1002/mrd.22493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 04/14/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Xiao-hang Che
- Division of Drugs and Pharmacology; Ningbo Institute of Medical Sciences; Ningbo China
- College of Chemistry and Bio-engineering; Yichun University; Yichun China
- Cancer Institute; Yinzhou People's Hospital; Ningbo China
| | - Yi-chen Chen
- Division of Drugs and Pharmacology; Ningbo Institute of Medical Sciences; Ningbo China
| | - Chun-lin Chen
- College of Chemistry and Bio-engineering; Yichun University; Yichun China
| | - Xiao-lei Ye
- Division of Drugs and Pharmacology; Ningbo Institute of Medical Sciences; Ningbo China
- Cancer Institute; Yinzhou People's Hospital; Ningbo China
| | - Hong Zhu
- Division of Obstetrics and Gynecology; Affiliated Hospital of Ningbo University School of Medicine; Ningbo China
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Nowak I, Płoski R, Barcz E, Dziunycz P, Kamiński P, Kostrzewa G, Milewski Ł, Roszkowski PI, Senitzer D, Malejczyk J, Kuśnierczyk P. KIR2DS5 in the presence of HLA-C C2 protects against endometriosis. Immunogenetics 2015; 67:203-9. [PMID: 25724317 PMCID: PMC4357646 DOI: 10.1007/s00251-015-0828-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 02/05/2015] [Indexed: 11/25/2022]
Abstract
Endometriosis is defined as the presence of functional endometrial tissue outside the uterine cavity. Several hypotheses have attempted to explain the etiology and pathogenesis of endometriosis. Recently, it has been suggested that a defect of the natural killer (NK) activity in the recognition and lysis of endometrial cells is one of the crucial points in the development of this disease. Natural killer cells can express killer immunoglobulin-like receptors (KIR), which recognize class I human leukocyte antigens on target cells. We asked whether polymorphisms in KIR, HLA-C, and HLA-B genes are risk factors for endometriosis. We tested 153 women with endometriosis diagnosed on the basis of laparoscopic and histological examination, and 213 control healthy women, who gave birth to at least one child. The frequency of KIR genes in patients was similar to that in controls except for KIR2DS5, which exerted a protective effect only in HLA-C C2-positive individuals. Moreover, KIR2DS5-positive women with endometriosis had 13 times lower chance that the disease would occupy the peritoneum than KIR2DS5- and KIR2DS4del-negative ones (OR = 0.077, P = 0.0061). Similarly, KIR2DS4del-positive endometriotic persons had 11 times lower chance for peritoneal disease (OR = 0.094, P < 0.001). Negative linkage disequilibrium between KIR2DS5 and KIR2DS4del indicates that these genes are mutually exclusive. Our data suggest that KIR2DS5 may be associated with protection from endometriosis, whereas KIR2DS4del seems to be associated with higher disease stages, possibly by exclusion of protective KIR2DS5.
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Affiliation(s)
- Izabela Nowak
- Laboratory of Immunogenetics and Tissue Immunology, Department of Clinical Immunology, Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, ul. Rudolfa Weigla 12, 53-114, Wrocław, Poland,
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Baranov VS, Ivaschenko TE, Liehr T, Yarmolinskaya MI. Systems genetics view of endometriosis: a common complex disorder. Eur J Obstet Gynecol Reprod Biol 2015; 185:59-65. [DOI: 10.1016/j.ejogrb.2014.11.036] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 11/20/2014] [Accepted: 11/27/2014] [Indexed: 11/29/2022]
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Aci�n P, Velasco I, Aci�n M, Capello C, Vela P. Epithelial Ovarian Cancers and Endometriosis. Gynecol Obstet Invest 2015; 79:126-35. [DOI: 10.1159/000367597] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 08/14/2014] [Indexed: 11/19/2022]
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Vergetaki A, Jeschke U, Vrekoussis T, Taliouri E, Sabatini L, Papakonstanti EA, Makrigiannakis A. Galectin-1 overexpression in endometriosis and its regulation by neuropeptides (CRH, UCN) indicating its important role in reproduction and inflammation. PLoS One 2014; 9:e114229. [PMID: 25473847 PMCID: PMC4256414 DOI: 10.1371/journal.pone.0114229] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 11/05/2014] [Indexed: 12/13/2022] Open
Abstract
Endometriosis is an inflammatory disease of women of reproductive age featured by the presence of ectopic endometrium and is strongly related to infertility. Galectins, carbonhydrate-binding proteins, have been found to have pro- or anti-inflammatory roles in the reproductive tract and in pathological conditions concerning infertility. Galectin-1, which is expressed at endometrium and decidua, plays a major role in implantation and trophoblast invasion. Also, the neuropeptides, corticotropin releasing hormone (CRH) and urocortin (UCN) and their receptors are expressed in eutopic and ectopic endometrium showing a differential expression pattern in endometriotic women compared to healthy ones. The aim of this study was to examine the galectin-1 expression in endometriotic lesions and compare its expression in eutopic endometrium of endometriotic and healthy women. Furthermore, we examined the effect of CRH and UCN in galectin-1 expression in Ishikawa cell line and macrophages and investigated the implication of CRHR1 in these responses. Eutopic and ectopic endometrium specimens, Ishikawa cell line and mice macrophages were used. Immunohistochemistry and western blot analysis were performed in order to identify galectin-1 expression in ectopic and eutopic endometrium of women with and without endometriosis and the regulatory effect of CRH and UCN on galectin-1 expression. This study presents for the first time that galectin-1 is overexpressed in endometriotic lesions compared to eutopic endometrium of endometriotic women and is more abundantly expressed in eutopic endometrium of disease women compared to healthy ones. Furthermore, it is shown that CRH and UCN upregulate galectin-1 expression in Ishikawa cell line and macrophages and this effect is mediated through CRHR1. These results suggest that galectin-1 might play an important role in endometriosis pathology and infertility profile of women suffering from endometriosis by being at the same time regulated by CRH and UCN interfering in the immune disequilibrium which characterizes this pathological condition.
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Affiliation(s)
- Aikaterini Vergetaki
- Department of Obstetrics and Gynecology, Medical School, University of Crete, Heraklion, Greece
| | - Udo Jeschke
- Department of Obstetrics and Gynecology, Innenstadt campus, Ludwig Maximilians University of Munich, Munich, Germany
| | - Thomas Vrekoussis
- Department of Obstetrics and Gynecology, Medical School, University of Ioannina, Ioannina, Greece
| | - Eirini Taliouri
- Department of Obstetrics and Gynecology, Medical School, University of Crete, Heraklion, Greece
| | - Luca Sabatini
- Centre for Reproductive Medicine, St Bartholomew's Hospital, London, United Kingdom
| | | | - Antonis Makrigiannakis
- Department of Obstetrics and Gynecology, Medical School, University of Crete, Heraklion, Greece
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da Silva CM, Vilaça Belo A, Passos Andrade S, Peixoto Campos P, Cristina França Ferreira M, Lopes da Silva-Filho A, Mendonça Carneiro M. Identification of local angiogenic and inflammatory markers in the menstrual blood of women with endometriosis. Biomed Pharmacother 2014; 68:899-904. [PMID: 25218120 DOI: 10.1016/j.biopha.2014.08.005] [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: 06/23/2014] [Accepted: 08/04/2014] [Indexed: 12/19/2022] Open
Abstract
The aim of this study was to evaluate the presence of myeloperoxidase (MPO), N-acetyl-β-D-glucosaminidase (NAG), tumor necrosis factor alpha (TNF-α) and vascular endothelial growth factor (VEGF) in peripheral and menstrual blood in women with (n=10) and without (n=7) endometriosis. NAG and MPO activities were evaluated by enzymatic methods, whereas TNF-α and VEGF by immunoassay. No significant differences were found for these markers, neither in menstrual nor in peripheral blood between groups. Menstrual blood NAG (P=0.039) and MPO (P=0.0117) activities in the endometriosis group were significantly higher than in peripheral blood. NAG and MPO presented positive linear correlation in peripheral (P=0.07; r=0.641) and menstrual blood (P=0.01; r=0.603). These findings point to the existence of an increased local inflammatory activity in women with endometriosis.
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Affiliation(s)
- Cláudia Maria da Silva
- Department of Obstetrics and Gynecology, School of Medicine, Federal University of Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, Brazil
| | - Andrezza Vilaça Belo
- Department of Obstetrics and Gynecology, School of Medicine, Federal University of Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, Brazil
| | - Sílvia Passos Andrade
- Department of Physiology and Biophysics, Federal University of Minas, Gerais (UFMG), Belo Horizonte, Brazil
| | - Paula Peixoto Campos
- Department of Physiology and Biophysics, Federal University of Minas, Gerais (UFMG), Belo Horizonte, Brazil
| | - Márcia Cristina França Ferreira
- Department of Obstetrics and Gynecology, School of Medicine, Federal University of Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, Brazil
| | - Agnaldo Lopes da Silva-Filho
- Department of Obstetrics and Gynecology, School of Medicine, Federal University of Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, Brazil
| | - Márcia Mendonça Carneiro
- Department of Obstetrics and Gynecology, School of Medicine, Federal University of Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, Brazil.
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Bastón JI, Barañao RI, Ricci AG, Bilotas MA, Olivares CN, Singla JJ, Gonzalez AM, Stupirski JC, Croci DO, Rabinovich GA, Meresman GF. Targeting galectin-1-induced angiogenesis mitigates the severity of endometriosis. J Pathol 2014; 234:329-37. [DOI: 10.1002/path.4397] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 06/04/2014] [Accepted: 06/22/2014] [Indexed: 12/13/2022]
Affiliation(s)
- Juan I Bastón
- Laboratorio de Fisiopatología Endometrial; Instituto de Biología y Medicina Experimental - Consejo Nacional de Investigaciones Científicas y Técnicas (IBYME-CONICET); Vuelta de Obligado 2490 Buenos Aires (C1428ADN) Argentina
| | - Rosa I Barañao
- Laboratorio de Inmunología de la Reproducción; Instituto de Biología y Medicina Experimental - Consejo Nacional de Investigaciones Científicas y Técnicas (IBYME-CONICET); Vuelta de Obligado 2490 Buenos Aires (C1428ADN) Argentina
| | - Analía G Ricci
- Laboratorio de Inmunología de la Reproducción; Instituto de Biología y Medicina Experimental - Consejo Nacional de Investigaciones Científicas y Técnicas (IBYME-CONICET); Vuelta de Obligado 2490 Buenos Aires (C1428ADN) Argentina
| | - Mariela A Bilotas
- Laboratorio de Inmunología de la Reproducción; Instituto de Biología y Medicina Experimental - Consejo Nacional de Investigaciones Científicas y Técnicas (IBYME-CONICET); Vuelta de Obligado 2490 Buenos Aires (C1428ADN) Argentina
| | - Carla N Olivares
- Laboratorio de Fisiopatología Endometrial; Instituto de Biología y Medicina Experimental - Consejo Nacional de Investigaciones Científicas y Técnicas (IBYME-CONICET); Vuelta de Obligado 2490 Buenos Aires (C1428ADN) Argentina
| | - José J Singla
- Hospital de Clínicas ‘José de San Martín’; Av. Córdoba 2351 Buenos Aires (C1120AAR) Argentina
| | - Alejandro M Gonzalez
- Hospital Naval de Buenos Aires ‘Cirujano Mayor Dr. Pedro Mallo’; Patricias Argentinas 351 Buenos Aires (C1405BWD) Argentina
| | - Juan C Stupirski
- Laboratorio de Inmunopatología; Instituto de Biología y Medicina Experimental - Consejo Nacional de Investigaciones Científicas y Técnicas (IBYME-CONICET); Vuelta de Obligado 2490 Buenos Aires (C1428ADN) Argentina
| | - Diego O Croci
- Laboratorio de Inmunopatología; Instituto de Biología y Medicina Experimental - Consejo Nacional de Investigaciones Científicas y Técnicas (IBYME-CONICET); Vuelta de Obligado 2490 Buenos Aires (C1428ADN) Argentina
| | - Gabriel A Rabinovich
- Laboratorio de Inmunopatología; Instituto de Biología y Medicina Experimental - Consejo Nacional de Investigaciones Científicas y Técnicas (IBYME-CONICET); Vuelta de Obligado 2490 Buenos Aires (C1428ADN) Argentina
| | - Gabriela F Meresman
- Laboratorio de Fisiopatología Endometrial; Instituto de Biología y Medicina Experimental - Consejo Nacional de Investigaciones Científicas y Técnicas (IBYME-CONICET); Vuelta de Obligado 2490 Buenos Aires (C1428ADN) Argentina
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Detection of the pan neuronal marker PGP9.5 by immuno-histochemistry and quantitative PCR in eutopic endometrium from women with and without endometriosis. Arch Gynecol Obstet 2014; 291:85-91. [PMID: 25047272 DOI: 10.1007/s00404-014-3379-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 07/09/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To assess endometrial gene as well as protein expression of neuroendocrine and supposedly endometriosis-associated product PGP9.5 and pain symptoms in women with endometriosis and controls undergoing laparoscopy, using molecular biological and immuno-histochemical approaches in the same patients. METHODS Biopsy of eutopic endometrium from 29 patients by sharp curettage, and preparation of paraffin blocks. Determination of PGP9.5 gene expression and protein abundance using qPCR and immuno-histochemistry. RESULTS qPCR; The PGP9.5 mRNA expression level between women with (N = 16) and without (N = 13) endometriosis was not different, regardless of pain symptoms or menstrual cycle phase. PGP9.5 expression was higher in women who reported pain compared to those who did not; however, this association was not statistically significant. The expression of PGP9.5 mRNA was higher in women with endometriosis and pain during the proliferative than in the secretory phase (P = 0.03). Furthermore, in the first half of the cycle, the abundance of the PGP9.5 transcript was also significantly higher in endometriosis patients compared to those without (P = 0.03). Immuno-histochemistry; Thirteen of the 16 endometriosis patients showed positive PGP9.5 immuno-reactivity in the endometrium, whereas no such signal was observed in women without endometriosis. The absolute number of nerve fibres per mm(2) in women with endometriosis was similar, regardless of the pain symptoms. CONCLUSIONS PGP9.5 mRNA expression is increased in the proliferative phase of endometriotic women with pain. The presence of nerve fibres was demonstrated by a PGP9.5 protein signal in immuno-histochemistry and restricted to patients with endometriosis. Based on these results, however, there did not appear to be a direct association between the gene expression and protein abundance in women with and without endometriosis or those that experienced pain.
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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: 70] [Impact Index Per Article: 7.0] [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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Abstract
ObjectivesThe objectives of this study were to evaluate the current evidence of the association of endometriosis and subsequent carcinoma of the ovary and to contextualize this evidence into daily practice issues.MethodsThis study is a critical review of observational and in vitro studies.ResultsAlthough the lifetime risk for ovarian cancer is low in general population and remains low in the broad spectrum of endometriosis, there may be clusters of individuals at higher risk of oncogenesis, whose identification would allow individualized surveillance and prophylactic interventions. Prevalence studies show that specific subtypes of ovarian cancer predominate in women with endometriosis. This has been validated in pathogenetic, genomic, immunobiologic, and hormonal studies.ConclusionsTaken together, these data provide a strong rationale for identifying, monitoring, counseling, and treating women with endometriosis who are at highest risk for cancer conversion.
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Zhang R, Zhou J, Li M, Ma H, Qiu J, Luo X, Jia Z. Ameliorating effect and potential mechanism of Rehmannia glutinosa oligosaccharides on the impaired glucose metabolism in chronic stress rats fed with high-fat diet. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2014; 21:607-614. [PMID: 24380735 DOI: 10.1016/j.phymed.2013.11.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 10/13/2013] [Accepted: 11/30/2013] [Indexed: 06/03/2023]
Abstract
The aim of this study was to determine whether the Rehmannia glutinosa oligosaccharides (ROS) ameliorate the impaired glucose metabolism and the potential mechanism in chronic stress rats fed with high-fat diet. The rats were fed by a high-fat diet and simultaneously stimulated by chronic stress over 5 weeks. Body weight, fasting plasma glucose, intraperitoneal glucose tolerance test (IPGTT), plasma lipids, gluconeogenesis test (GGT), glycogen content, and corticosterone, insulin and leptin levels were measured. The results showed that ROS administration (100, 200 mg/kg, i.g.) for 5 weeks exerted the effects of increasing the organ weights of thymus and spleen, lowering the fasting plasma glucose level, improving impaired glucose tolerance, increasing the contents of liver and muscle glycogen, decreasing the gluconeogenesis ability, plasma-free fatty acid's level, as well as plasma triglyceride and total cholesterol levels in chronic stress and high-fat fed rats, especially in the group of 200mg/kg; while the plasma corticosterone level was decreased, and plasma leptin level was increased. These results suggest that ROS exert an ameliorating effect of impaired glucose metabolism in chronic stress rats fed with high-fat diet, and the potential mechanism may be mediated through rebuilding the glucose homeostasis in the neuroendocrine immuno-modulation (NIM) network through multilinks and multitargets.
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Affiliation(s)
- Ruxue Zhang
- Department of Pharmacy, Lanzhou General Hospital of PLA, Lanzhou, China.
| | - Jun Zhou
- Department of Pharmacy, Lanzhou General Hospital of PLA, Lanzhou, China
| | - Maoxing Li
- Department of Pharmacy, Lanzhou General Hospital of PLA, Lanzhou, China
| | - Haigang Ma
- Department of Pharmacy, Lanzhou General Hospital of PLA, Lanzhou, China; College of Life Sciences, Lanzhou University, Lanzhou, China
| | - Jianguo Qiu
- Department of Pharmacy, Lanzhou General Hospital of PLA, Lanzhou, China
| | - Xiaohong Luo
- Department of Endocrinology, Lanzhou General Hospital of PLA, Lanzhou, China
| | - Zhengping Jia
- Department of Pharmacy, Lanzhou General Hospital of PLA, Lanzhou, China.
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Tang Q, Shang F, Wang X, Yang Y, Chen G, Chen Y, Zhang J, Xu X. Combination use of ferulic acid, ligustrazine and tetrahydropalmatine inhibits the growth of ectopic endometrial tissue: a multi-target therapy for endometriosis rats. JOURNAL OF ETHNOPHARMACOLOGY 2014; 151:1218-1225. [PMID: 24389027 DOI: 10.1016/j.jep.2013.12.047] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 11/16/2013] [Accepted: 12/24/2013] [Indexed: 06/03/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Ferulic acid (FA), ligustrazine (LZ) and tetrahydropalmatine (THP) are separately isolated from Chinese Angelica, Szechwan Lovage Rhizome and Rhizoma in the Jiawei-Foshou-San formula, a popular traditional Chinese medicine for irregular menses. It has been reported that the combination use of FA+LZ+THP has similar effect on endometriosis, but the underlying mechanisms are unclear. This study was to investigate the combination effects and mechanisms of FA+LZ+THP on endometriosis rats. MATERIALS AND METHODS Fifty endometriosis rats were intragastricly treated with FA+LZ+THP for 4 wk. The volume of ectopic endometrial tissue was measured to evaluate the effects. Then the changes in hypothalamic-pituitary-ovarian axis and ERE pathway were indicated by the levels of E2, GnRH, FSH and LH, and the expressions of ER, HSP90 and COX-2, respectively. In addition, peritoneal macrophages of each rat were cultured in vitro and treated with (FA+LZ+THP)-medicated serum for 24h. The proliferation and phagocytosis abilities, the levels of IL-1β and TNF-α, and the expression of IκBα were then measured for the changes of peritoneal macrophage activities. RESULTS Combination use of FA+LZ+THP diminished the volume of the ectopic endometrial tissues (P<0.05 or P<0.01). It also decreased the E2 level, suppressed the expression of GnRH, FSH and LH, and decreased the protein expression of ER, HSP90 and COX-2 (all P<0.05 or P<0.01). The phagocytosis ability of peritoneal macrophage was enhanced by (FA+LZ+THP)-medicated serum (P<0.05) with no change of proliferation (P>0.05). Moreover, IL-1β and TNF-α were downregulated (both P<0.05 or P<0.01) and IκBα was upregulated by the (FA+LZ+THP)-medicated serum (P<0.01). CONCLUSIONS The combination use of FA, LZ and THP could inhibit the growth of ectopic endometrial tissue in endometriosis rats. It might be related to the down-regulation of hypothalamic-pituitary-ovarian axis, the amelioration in ERE pathway and the improvement of peritoneal macrophage activities.
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Affiliation(s)
- Qing Tang
- College of Pharmaceutical Sciences & College of Traditional Chinese Medicine, Southwest University, Chongqing 400715, China; Institute of Chinese Medicine, Southwest University, Chongqing 400715, China; Pharmacology of Chinese Materia Medica, The Key Constructing Discipline by the State Administrative Bureau of Traditional Chinese Medicine, Chongqing 400715, China
| | - Fanghong Shang
- College of Pharmaceutical Sciences & College of Traditional Chinese Medicine, Southwest University, Chongqing 400715, China; Institute of Chinese Medicine, Southwest University, Chongqing 400715, China; Pharmacology of Chinese Materia Medica, The Key Constructing Discipline by the State Administrative Bureau of Traditional Chinese Medicine, Chongqing 400715, China
| | - Xiaocui Wang
- College of Pharmaceutical Sciences & College of Traditional Chinese Medicine, Southwest University, Chongqing 400715, China; Institute of Chinese Medicine, Southwest University, Chongqing 400715, China; Pharmacology of Chinese Materia Medica, The Key Constructing Discipline by the State Administrative Bureau of Traditional Chinese Medicine, Chongqing 400715, China
| | - Yang Yang
- College of Pharmaceutical Sciences & College of Traditional Chinese Medicine, Southwest University, Chongqing 400715, China; Institute of Chinese Medicine, Southwest University, Chongqing 400715, China; Pharmacology of Chinese Materia Medica, The Key Constructing Discipline by the State Administrative Bureau of Traditional Chinese Medicine, Chongqing 400715, China
| | - Gang Chen
- Research Center of Medical Chemistry and Chemical Biology, Chongqing Technology and Business University, Chongqing 400067, China
| | - Yi Chen
- College of Pharmaceutical Sciences & College of Traditional Chinese Medicine, Southwest University, Chongqing 400715, China; Institute of Chinese Medicine, Southwest University, Chongqing 400715, China; Pharmacology of Chinese Materia Medica, The Key Constructing Discipline by the State Administrative Bureau of Traditional Chinese Medicine, Chongqing 400715, China
| | - Jifen Zhang
- College of Pharmaceutical Sciences & College of Traditional Chinese Medicine, Southwest University, Chongqing 400715, China; Institute of Chinese Medicine, Southwest University, Chongqing 400715, China; Pharmacology of Chinese Materia Medica, The Key Constructing Discipline by the State Administrative Bureau of Traditional Chinese Medicine, Chongqing 400715, China
| | - Xiaoyu Xu
- College of Pharmaceutical Sciences & College of Traditional Chinese Medicine, Southwest University, Chongqing 400715, China; Institute of Chinese Medicine, Southwest University, Chongqing 400715, China; Pharmacology of Chinese Materia Medica, The Key Constructing Discipline by the State Administrative Bureau of Traditional Chinese Medicine, Chongqing 400715, China.
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Slominski AT, Zmijewski MA, Zbytek B, Tobin DJ, Theoharides TC, Rivier J. Key role of CRF in the skin stress response system. Endocr Rev 2013; 34:827-84. [PMID: 23939821 PMCID: PMC3857130 DOI: 10.1210/er.2012-1092] [Citation(s) in RCA: 282] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 08/02/2013] [Indexed: 02/08/2023]
Abstract
The discovery of corticotropin-releasing factor (CRF) or CRH defining the upper regulatory arm of the hypothalamic-pituitary-adrenal (HPA) axis, along with the identification of the corresponding receptors (CRFRs 1 and 2), represents a milestone in our understanding of central mechanisms regulating body and local homeostasis. We focused on the CRF-led signaling systems in the skin and offer a model for regulation of peripheral homeostasis based on the interaction of CRF and the structurally related urocortins with corresponding receptors and the resulting direct or indirect phenotypic effects that include regulation of epidermal barrier function, skin immune, pigmentary, adnexal, and dermal functions necessary to maintain local and systemic homeostasis. The regulatory modes of action include the classical CRF-led cutaneous equivalent of the central HPA axis, the expression and function of CRF and related peptides, and the stimulation of pro-opiomelanocortin peptides or cytokines. The key regulatory role is assigned to the CRFR-1α receptor, with other isoforms having modulatory effects. CRF can be released from sensory nerves and immune cells in response to emotional and environmental stressors. The expression sequence of peptides includes urocortin/CRF→pro-opiomelanocortin→ACTH, MSH, and β-endorphin. Expression of these peptides and of CRFR-1α is environmentally regulated, and their dysfunction can lead to skin and systemic diseases. Environmentally stressed skin can activate both the central and local HPA axis through either sensory nerves or humoral factors to turn on homeostatic responses counteracting cutaneous and systemic environmental damage. CRF and CRFR-1 may constitute novel targets through the use of specific agonists or antagonists, especially for therapy of skin diseases that worsen with stress, such as atopic dermatitis and psoriasis.
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Affiliation(s)
- Andrzej T Slominski
- MD, PhD, Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center; 930 Madison Avenue, Suite 500, Memphis, Tennessee 38163.
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