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Badary DM, Abou-Taleb HA, Ibrahim M. Hypoxia-inducible Factor-1α and mTOR as a Potential Therapeutic Target in Endometriosis: An Immunohistochemical Study. Appl Immunohistochem Mol Morphol 2023; 31:629-634. [PMID: 37668418 DOI: 10.1097/pai.0000000000001148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 08/01/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND AND STUDY AIM We aim to study the immunohistochemical expression of both hypoxia-inducible factor-1α (HIF-1α) and mammalian target of rapamycin (mTOR) in endometriosis to provide new evidence for a targeted endometriosis therapy. PATIENTS AND METHODS This study comprised 106 endometriotic cases diagnosed clinically and histopathologically. The immunohistochemical method was done to determine the expression of HIF-1α and mTOR. RESULTS Endometriotic glands showed significant cytoplasmic expression of both markers in patients with poor ovulation, severe endometriosis, and infertile for >2 years ( P <0.001). Also, patients with intense and worst pain show significant immunohistochemical expression of both markers ( P <0.001). There is a significant correlation between mTOR and HIF-1α expression in endometriotic tissue samples as P <0.001. CONCLUSIONS Our data suggest that both mTOR and its downstream target HIF-1α transcription factor are both disrupted in patients with endometriosis, which is consistent with aberrant activation of these pathways and their possible contribution to the pathogenesis of endometriosis. These results could offer a promising novel opportunity to be blocked therapeutically. As new management options need to be refined in particular in severe cases and infertile patients with endometriosis, therefore future studies are warranted to investigate treating endometriosis with mTOR inhibitors; the latter are already in clinical trials in phase III and IV, treating solid tumors as well as non-neoplastic disorders.
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Affiliation(s)
- Dalia M Badary
- Obstetrics and Gynecology, Faculty of Medicine, Assiut University
| | | | - Maha Ibrahim
- Department of Cancer Pathology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
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Malvezzi H, Marengo EB, Podgaec S, Piccinato CDA. Endometriosis: current challenges in modeling a multifactorial disease of unknown etiology. J Transl Med 2020; 18:311. [PMID: 32787880 PMCID: PMC7425005 DOI: 10.1186/s12967-020-02471-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/28/2020] [Indexed: 02/07/2023] Open
Abstract
Endometriosis is a chronic inflammatory hormone-dependent condition associated with pelvic pain and infertility, characterized by the growth of ectopic endometrium outside the uterus. Given its still unknown etiology, treatments usually aim at diminishing pain and/or achieving pregnancy. Despite some progress in defining mode-of-action for drug development, the lack of reliable animal models indicates that novel approaches are required. The difficulties inherent to modeling endometriosis are related to its multifactorial nature, a condition that hinders the recreation of its pathology and the identification of clinically relevant metrics to assess drug efficacy. In this review, we report and comment endometriosis models and how they have led to new therapies. We envision a roadmap for endometriosis research, integrating Artificial Intelligence, three-dimensional cultures and organ-on-chip models as ways to achieve better understanding of physiopathological features and better tailored effective treatments.
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Affiliation(s)
- Helena Malvezzi
- Hospital Israelita Albert Einstein, São Paulo, SP 05652-900 Brazil
| | - Eliana Blini Marengo
- Instituto Butanta- EstabilidadeBiotech Quality Control, São Paulo, SP 05503-900 Brazil
| | - Sérgio Podgaec
- Hospital Israelita Albert Einstein, São Paulo, SP 05652-900 Brazil
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Viganò P, Ottolina J, Bartiromo L, Bonavina G, Schimberni M, Villanacci R, Candiani M. Cellular Components Contributing to Fibrosis in Endometriosis: A Literature Review. J Minim Invasive Gynecol 2019; 27:287-295. [PMID: 31785417 DOI: 10.1016/j.jmig.2019.11.011] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/31/2019] [Accepted: 11/21/2019] [Indexed: 12/17/2022]
Abstract
Endometriosis-related fibrosis represents a complex phenomenon with underlying mechanisms yet to be clarified. Fibrosis is consistently present in all disease forms and contributes to classic endometriosis-related symptoms of pain and infertility. The purpose of this literature review was to examine the role of various cellular populations and biologic mechanisms and signaling pathways in inducing fibrogenesis of endometriotic lesions. A search was performed through PubMed and MEDLINE for animal and human studies published in English in the last 23 years that examined fibrosis in superficial, ovarian, and deep infiltrating endometriosis. The main cell types found to be involved in the development of fibrosis were platelets, macrophages, ectopic endometrial cells, and sensory nerve fibers. Interactions among each of the cell types contribute to the production of fibrosis through the production of soluble factors, mostly transforming growth factor-β but also other cytokines and neuropeptides. Cell types known to be critical to the pathophysiology of endometriosis also contribute to fibrogenesis, thus supporting the theory that fibrosis is an inherent part of endometriosis.
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Affiliation(s)
- Paola Viganò
- Reproductive Sciences Lab, Division of Genetics and Cell Biology (Dr. Vigano).
| | - Jessica Ottolina
- Gynecology/Obstetrics Unit (Drs. Ottolina, Bartiromo, Bonavina, Schimberni, Villanacci, and Candiani), San Raffaele Scientific Institute, Milan, Italy
| | - Ludovica Bartiromo
- Gynecology/Obstetrics Unit (Drs. Ottolina, Bartiromo, Bonavina, Schimberni, Villanacci, and Candiani), San Raffaele Scientific Institute, Milan, Italy
| | - Giulia Bonavina
- Gynecology/Obstetrics Unit (Drs. Ottolina, Bartiromo, Bonavina, Schimberni, Villanacci, and Candiani), San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Schimberni
- Gynecology/Obstetrics Unit (Drs. Ottolina, Bartiromo, Bonavina, Schimberni, Villanacci, and Candiani), San Raffaele Scientific Institute, Milan, Italy
| | - Roberta Villanacci
- Gynecology/Obstetrics Unit (Drs. Ottolina, Bartiromo, Bonavina, Schimberni, Villanacci, and Candiani), San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Candiani
- Gynecology/Obstetrics Unit (Drs. Ottolina, Bartiromo, Bonavina, Schimberni, Villanacci, and Candiani), San Raffaele Scientific Institute, Milan, Italy
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Greene AD, Lang SA, Kendziorski JA, Sroga-Rios JM, Herzog TJ, Burns KA. Endometriosis: where are we and where are we going? Reproduction 2016; 152:R63-78. [PMID: 27165051 DOI: 10.1530/rep-16-0052] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 05/09/2016] [Indexed: 12/25/2022]
Abstract
Endometriosis currently affects ~5.5 million reproductive-aged women in the U.S. with symptoms such as painful periods (dysmenorrhea), chronic pelvic pain, pain with intercourse (dyspareunia), and infertility. It is defined as the presence of endometrial tissue outside the uterine cavity and is found predominately attached to sites within the peritoneal cavity. Diagnosis for endometriosis is solely made through surgery as no consistent biomarkers for disease diagnosis exist. There is no cure for endometriosis and treatments only target symptoms and not the underlying mechanism(s) of disease. The nature of individual predisposing factors or inherent defects in the endometrium, immune system, and/or peritoneal cavity of women with endometriosis remains unclear. The literature over the last 5 years (2010-2015) has advanced our critical knowledge related to hormones, hormone receptors, immune dysregulation, hormonal treatments, and the transformation of endometriosis to ovarian cancer. In this review, we cover the aforementioned topics with the goal of providing the reader an overview and related references for further study to highlight the progress made in endometriosis research, while concluding with critical areas of endometriosis research that are urgently needed.
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Affiliation(s)
- Alexis D Greene
- Department of Obstetrics and GynecologyUniversity of Cincinnati Center for Reproductive Health, Cincinnati, Ohio, USA
| | - Stephanie A Lang
- Department of Environmental HealthUniversity of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jessica A Kendziorski
- Department of Environmental HealthUniversity of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Julie M Sroga-Rios
- Department of Obstetrics and GynecologyUniversity of Cincinnati Center for Reproductive Health, Cincinnati, Ohio, USA
| | - Thomas J Herzog
- Department of Obstetrics and GynecologyUniversity of Cincinnati Center for Reproductive Health, Cincinnati, Ohio, USA University of Cincinnati Cancer InstituteUniversity of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Katherine A Burns
- Department of Environmental HealthUniversity of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Ren XU, Wang Y, Xu G, Dai L. Effect of rapamycin on endometriosis in mice. Exp Ther Med 2016; 12:101-106. [PMID: 27347023 PMCID: PMC4907216 DOI: 10.3892/etm.2016.3280] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 03/14/2016] [Indexed: 12/16/2022] Open
Abstract
The aims of the present study were to investigate the impact of rapamycin (RAPA) on the endometriosis (EMS) lesions in severe combined immunodeficiency (SCID) mice, and to examine the possible mechanism involved in a novel therapy in EMS. Following the successful establishment of an EMS-SCID mouse model, the mice were randomly assigned into the RAPA, control and saline treatment groups. Subsequent to treatment for 2 weeks, the serum hypoxia-inducible factor-1α (HIF-1α) and vascular endothelial growth factor (VEGF) were detected using ELISA. The levels of HIF-1α and VEGF, as well as the size of EMS lesions, were compared among the three groups. In addition, the HIF-1α, VEGF and CD34 protein expression levels, and the microvessel density (MVD) of the lesions were determined by immunohistochemical analysis. Compared with the control and saline groups, the volume of EMS lesions in the RAPA-treated SCID mice was significantly reduced. Furthermore, the serum level and protein expression of VEGF, and the MVD in the lesions of the RAPA-treated group were significantly reduced when compared with the other two groups. These parameters were comparable in the control and saline groups. In conclusion, RAPA may inhibit the growth of endometriotic lesions, most possibly through the inhibition of the expression of VEGF in lesions, thereby inhibiting angiogenesis.
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Affiliation(s)
- X U Ren
- Department of Obstetrics and Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510282, P.R. China; Department of Obstetrics and Gynecology, Guangzhou Red Cross Hospital, Guangzhou, Guangdong 510120, P.R. China
| | - Yifeng Wang
- Department of Obstetrics and Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510282, P.R. China
| | - Gang Xu
- Department of Endocrinology, Guangzhou Red Cross Hospital, Guangzhou, Guangdong 510120, P.R. China
| | - Libing Dai
- Department of Obstetrics and Gynecology, Guangzhou Red Cross Hospital, Guangzhou, Guangdong 510120, P.R. China
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Zhan L, Wang W, Zhang Y, Song E, Fan Y, Wei B. Hypoxia-inducible factor-1alpha: A promising therapeutic target in endometriosis. Biochimie 2016; 123:130-7. [DOI: 10.1016/j.biochi.2016.01.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 01/15/2016] [Indexed: 12/15/2022]
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Additional B-cell deficiency does not affect growth and angiogenesis of ectopic human endometrium in T-cell-deficient endometriosis mouse models during long-term culture. J Reprod Immunol 2014; 106:50-7. [DOI: 10.1016/j.jri.2014.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 07/07/2014] [Accepted: 08/11/2014] [Indexed: 01/23/2023]
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