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Soni UK, Tripathi R, Jha RK. MCP-1 exerts the inflammatory response via ILK activation during endometriosis pathogenesis. Life Sci 2024; 353:122902. [PMID: 39004271 DOI: 10.1016/j.lfs.2024.122902] [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: 09/29/2023] [Revised: 06/18/2024] [Accepted: 07/06/2024] [Indexed: 07/16/2024]
Abstract
AIMS MCP-1 has been shown to be elevated in endometriosis. ILK functions in several cellular events and interacts with MCP-1-signaling. In the current study, we evaluated the role of MCP-1-ILK signaling in human endometriotic cell's (Hs832(C).TCs) potential for colonization, invasion, adhesion, etc. and differentiation of macrophage along with inflammation in an endometriosis mouse model. MATERIALS AND METHODS A mouse model of endometriosis with elevated levels of MCP-1 was developed by injecting MCP-1. We examined the migration, adhesion, colonization and invasion of Hs832(C).TCs in response to MCP-1-ILK signaling. We also examined the differentiation of THP-1 cells to macrophage in response to MCP-1-ILK signaling. KEY FINDINGS We observed that MCP-1 increased Ser246 phosphorylation of ILK in Hs832(C).TCs and enhanced the migration, adhesion, colonization, and invasion of Hs832(C).TCs. In the mouse model of endometriosis, we found elevated chemokines (CCL-11, CCL-22 and CXCL13) levels. An increased level of MCP-1 mediated ILK activation, leading to increased inflammatory reaction and infiltration of residential and circulatory macrophages, and monocyte differentiation, but suppressed the anti-inflammatory reaction. The inhibitor (CPD22) of ILK reversed the MCP-1-mediated action by restoring Hs832(C).TCs and THP-1 phenotype. ILK inhibition in a mouse model of endometriosis reduced the effects of MCP-1 mediated pro-inflammatory cytokines, but increased anti-inflammatory response along with T-regulatory and T-helper cell restoration. SIGNIFICANCE Targeting ILK restores MCP-1 milieu in the peritoneal cavity and endometrial tissues, reduces the inflammatory response, improves the T-regulatory and T-helper cells in the endometriosis mouse model and decreases the migration, adhesion, colonization and invasion of endometriotic cells.
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Affiliation(s)
- Upendra Kumar Soni
- Endocrinology Division, Council of Scientific and Industrial; Research (CSIR)-Central Drug Research Institute (CDRI), Sector-10, Jankipuram Extension, Sitapur Road, Lucknow 226031, U.P., India
| | - Rupal Tripathi
- Endocrinology Division, Council of Scientific and Industrial; Research (CSIR)-Central Drug Research Institute (CDRI), Sector-10, Jankipuram Extension, Sitapur Road, Lucknow 226031, U.P., India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Rajesh Kumar Jha
- Endocrinology Division, Council of Scientific and Industrial; Research (CSIR)-Central Drug Research Institute (CDRI), Sector-10, Jankipuram Extension, Sitapur Road, Lucknow 226031, U.P., India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India.
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Suszczyk D, Skiba W, Pawłowska-Łachut A, Dymanowska-Dyjak I, Włodarczyk K, Paduch R, Wertel I. Immune Checkpoints in Endometriosis-A New Insight in the Pathogenesis. Int J Mol Sci 2024; 25:6266. [PMID: 38892453 PMCID: PMC11172867 DOI: 10.3390/ijms25116266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/29/2024] [Accepted: 06/03/2024] [Indexed: 06/21/2024] Open
Abstract
Endometriosis (EMS) is an oestrogen-dependent, chronic disease affecting women of a reproductive age. One of the important factors involved in the development of this disease is the complex disorders associated with the functioning of the immune system. Recent evidence has shown that EMS development is associated with changes in systemic and local immunity, including functional disturbances of effector and antigen-presenting cells. One of the reasons for immune imbalance can be the improper expression of immune checkpoints (ICPs). ICPs and their ligands are responsible for maintaining self-tolerance and the modulation of the initiation, duration, and magnitude of the immune response of effector cells in normal tissues to avoid tissue damage. Considering the complex nature of co-stimulatory or co-inhibitory ICPs and the signalling between effector cells and APCs, we hypothesise that changes in cells' activity caused by ICPs may lead to serious immune system disturbances in patients with endometriosis. Moreover, both upregulation and downregulation in the expression of ICPs may be implicated in this process, including the reduced activity of effector cells against endometrial implants and disturbances in the antigen-presenting process. In this narrative review, we discuss, for the first time, key findings from the emerging literature, describing the associations between ICPs and their possible implication in the pathogenesis of endometriosis.
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Affiliation(s)
- Dorota Suszczyk
- Independent Laboratory of Cancer Diagnostics and Immunology, Medical University of Lublin, Chodźki 1, 20-093 Lublin, Poland; (D.S.); (W.S.); (A.P.-Ł.); (K.W.)
| | - Wiktoria Skiba
- Independent Laboratory of Cancer Diagnostics and Immunology, Medical University of Lublin, Chodźki 1, 20-093 Lublin, Poland; (D.S.); (W.S.); (A.P.-Ł.); (K.W.)
| | - Anna Pawłowska-Łachut
- Independent Laboratory of Cancer Diagnostics and Immunology, Medical University of Lublin, Chodźki 1, 20-093 Lublin, Poland; (D.S.); (W.S.); (A.P.-Ł.); (K.W.)
| | - Izabela Dymanowska-Dyjak
- Independent Laboratory of Minimally Invasive Gynecology and Gynecological Endocrinology, Medical University of Lublin, Staszica 16, 20-081 Lublin, Poland;
| | - Karolina Włodarczyk
- Independent Laboratory of Cancer Diagnostics and Immunology, Medical University of Lublin, Chodźki 1, 20-093 Lublin, Poland; (D.S.); (W.S.); (A.P.-Ł.); (K.W.)
| | - Roman Paduch
- Department of Virology and Immunology, Institute of Microbiology and Biotechnology, Faculty of Biology and Biotechnology, Maria Curie-Skłodowska University, Akademicka 19, 20-033 Lublin, Poland;
| | - Iwona Wertel
- Independent Laboratory of Cancer Diagnostics and Immunology, Medical University of Lublin, Chodźki 1, 20-093 Lublin, Poland; (D.S.); (W.S.); (A.P.-Ł.); (K.W.)
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3
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Chiarle G, Allais G, Sinigaglia S, Airola G, Rolando S, Bergandi F, Micalef S, Benedetto C. Acupuncture for pain and pain-related disability in deep infiltrating endometriosis. FRONTIERS IN PAIN RESEARCH 2024; 5:1279312. [PMID: 38524269 PMCID: PMC10957595 DOI: 10.3389/fpain.2024.1279312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 02/26/2024] [Indexed: 03/26/2024] Open
Abstract
Objectives To evaluate the efficacy of acupuncture in relieving symptoms (dysmenorrhea, dyspareunia, pelvic pain and dyschezia) intensity, improving functional disability, reducing the number of days per months of dysmenorrhea, the frequency and the efficacy of analgesic use in deep infiltrating endometriosis (DIE). The safety profile was also evaluated. Methods The study sample was 34 patients with DIE; for 2 months (T-2, T-1) the women recorded diary notes on the numbers of days of menstruation, the presence, intensity, and disability related to dysmenorrhea, dyspareunia, pelvic pain, and dyschezia. They then received a total of 15 acupuncture treatments over 6 months (T1-T6; once a week for 12 weeks, then once a month for 3 months). Results Dysmenorrhea intensity was decreased during treatment. A decrease of at least 50% in number of days of dysmenorrhea, and a decrease in moderate-to-severe disability starting from T1 to T6 was recorded for 58.6% of patients. Dyspareunia intensity steadily decreased starting at T2; the percentage of women with moderate-to-severe disability declined from 73.3% at T-2, to 36.9% at T3, T4, and T5. A decrease in pelvic pain score was noted starting at T1; the percentage of disability decreased from 83.3% at T-2 to 33.3% at T3 and T6. The intensity of dyschezia decreased from T-2 to T3 and T4 and then increased slightly. Analgesic drug use was lower during treatment and its efficacy appeared to be greater. Conclusions The limitations notwithstanding our study-findings show that acupuncture was safe and effective in reducing pain intensity and symptoms-related disability. Larger-scale studies are needed to compare acupuncture and pharmacotherapy for endometriosis-related pain.
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Affiliation(s)
- Giulia Chiarle
- Women’s Headache Center, Gynaecology and Obstetrics Unit, Sant’Anna Hospital, University of Turin, Turin, Italy
- Department of Gynaecology and Obstetrics, University of Turin, Turin, Italy
- Gynaecology and Obstetrics Unit, Sant’Anna Hospital, University of Turin, Turin, Italy
| | - Gianni Allais
- Women’s Headache Center, Gynaecology and Obstetrics Unit, Sant’Anna Hospital, University of Turin, Turin, Italy
- Department of Gynaecology and Obstetrics, University of Turin, Turin, Italy
| | - Silvia Sinigaglia
- Women’s Headache Center, Gynaecology and Obstetrics Unit, Sant’Anna Hospital, University of Turin, Turin, Italy
- Department of Gynaecology and Obstetrics, University of Turin, Turin, Italy
| | - Gisella Airola
- Women’s Headache Center, Gynaecology and Obstetrics Unit, Sant’Anna Hospital, University of Turin, Turin, Italy
- Department of Gynaecology and Obstetrics, University of Turin, Turin, Italy
| | - Sara Rolando
- Women’s Headache Center, Gynaecology and Obstetrics Unit, Sant’Anna Hospital, University of Turin, Turin, Italy
| | - Fabiola Bergandi
- Women’s Headache Center, Gynaecology and Obstetrics Unit, Sant’Anna Hospital, University of Turin, Turin, Italy
| | - Salvatore Micalef
- Gynaecology and Obstetrics Unit, Sant’Anna Hospital, University of Turin, Turin, Italy
| | - Chiara Benedetto
- Women’s Headache Center, Gynaecology and Obstetrics Unit, Sant’Anna Hospital, University of Turin, Turin, Italy
- Gynaecology and Obstetrics Unit, Sant’Anna Hospital, University of Turin, Turin, Italy
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Spagnolo E, Martinez A, Mascarós-Martínez A, Marí-Alexandre J, Carbonell M, González-Cantó E, Pena-Burgos EM, Mc Cormack BA, Tomás-Pérez S, Gilabert-Estellés J, López-Carrasco A, Hidalgo P, Ángeles MA, Redondo A, Gallego A, Hernández A. Evaluation of Immune Infiltrates in Ovarian Endometriosis and Endometriosis-Associated Ovarian Cancer: Relationship with Histological and Clinical Features. Int J Mol Sci 2023; 24:12083. [PMID: 37569458 PMCID: PMC10418839 DOI: 10.3390/ijms241512083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND the association between ovarian endometriosis (OE) and endometriosis-associated ovarian cancer (EAOC) is extensively documented, and misfunction of the immune system might be involved. The primary objective of this study was to identify and compare the spatial distribution of tumour-infiltrating lymphocytes (TILs) and tumour-associated macrophages (TAMs) in OE and EAOC. Secondary objectives included the analysis of the relationship between immunosuppressive populations and T-cell exhaustion markers in both groups. METHODS TILs (CD3, CD4, and CD8) and macrophages (CD163) were assessed by immunochemistry. Exhaustion markers (PD-1, TIM3, CD39, and FOXP3) and their relationship with tumour-associated macrophages (CD163) were assessed by immunofluorescence on paraffin-embedded samples from n = 43 OE and n = 54 EAOC patients. RESULTS we observed a predominantly intraepithelial CD3+ distribution in OE but both an intraepithelial and stromal pattern in EAOC (p < 0.001). TILs were more abundant in OE (p < 0.001), but higher TILs significantly correlated with a longer overall survival and disease-free survival in EAOC (p < 0.05). CD39 and FOXP3 significantly correlated with each other and CD163 (p < 0.05) at the epithelial level in moderate/intense CD4 EAOC, whereas in moderate/intense CD8+, PD-1+ and TIM3+ significantly correlated (p = 0.009). Finally, T-cell exhaustion markers FOXP3-CD39 were decreased and PD-1-TIM3 were significantly increased in EAOC (p < 0.05). CONCLUSIONS the dysregulation of TILs, TAMs, and T-cell exhaustion might play a role in the malignization of OE to EAOC.
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Affiliation(s)
- Emanuela Spagnolo
- Department of Gynecology, La Paz University Hospital, 28046 Madrid, Spain; (E.S.); (M.C.); (A.L.-C.); (A.H.)
- Research Institute “IdiPaz”, La Paz University Hospital, 28046 Madrid, Spain
| | - Alejandra Martinez
- Department of Surgical Oncology, Institut Claudius Regaud-Institut Universitaire du Cancer du Toulouse (IUCT) Oncopole, 31059 Toulouse, France; (A.M.); (M.A.Á.)
- Centre de Recherches en Cancérologie de Toulouse, UMR 1037 INSERM, 31100 Toulouse, France
| | | | - Josep Marí-Alexandre
- Department of Pathology, General University Hospital of Valencia, 46014 Valencia, Spain;
- Research Laboratory in Biomarkers in Reproduction, Obstetrics and Gynecology, Research Foundation, General University Hospital of Valencia, 46014 Valencia, Spain; (E.G.-C.); (B.A.M.C.); (S.T.-P.); (J.G.-E.)
| | - María Carbonell
- Department of Gynecology, La Paz University Hospital, 28046 Madrid, Spain; (E.S.); (M.C.); (A.L.-C.); (A.H.)
- Research Institute “IdiPaz”, La Paz University Hospital, 28046 Madrid, Spain
| | - Eva González-Cantó
- Research Laboratory in Biomarkers in Reproduction, Obstetrics and Gynecology, Research Foundation, General University Hospital of Valencia, 46014 Valencia, Spain; (E.G.-C.); (B.A.M.C.); (S.T.-P.); (J.G.-E.)
| | | | - Bárbara Andrea Mc Cormack
- Research Laboratory in Biomarkers in Reproduction, Obstetrics and Gynecology, Research Foundation, General University Hospital of Valencia, 46014 Valencia, Spain; (E.G.-C.); (B.A.M.C.); (S.T.-P.); (J.G.-E.)
| | - Sarai Tomás-Pérez
- Research Laboratory in Biomarkers in Reproduction, Obstetrics and Gynecology, Research Foundation, General University Hospital of Valencia, 46014 Valencia, Spain; (E.G.-C.); (B.A.M.C.); (S.T.-P.); (J.G.-E.)
| | - Juan Gilabert-Estellés
- Research Laboratory in Biomarkers in Reproduction, Obstetrics and Gynecology, Research Foundation, General University Hospital of Valencia, 46014 Valencia, Spain; (E.G.-C.); (B.A.M.C.); (S.T.-P.); (J.G.-E.)
- Department of Obstetrics and Gynecology, General University Hospital of Valencia, 46014 Valencia, Spain
- Department of Paediatrics, Obstetrics and Gynaecology, University of Valencia, 46010 Valencia, Spain
| | - Ana López-Carrasco
- Department of Gynecology, La Paz University Hospital, 28046 Madrid, Spain; (E.S.); (M.C.); (A.L.-C.); (A.H.)
- Research Institute “IdiPaz”, La Paz University Hospital, 28046 Madrid, Spain
| | - Paula Hidalgo
- Department of Radiology, La Paz University Hospital, 28046 Madrid, Spain;
| | - Martina Aida Ángeles
- Department of Surgical Oncology, Institut Claudius Regaud-Institut Universitaire du Cancer du Toulouse (IUCT) Oncopole, 31059 Toulouse, France; (A.M.); (M.A.Á.)
| | - Andrés Redondo
- Department of Medical Oncology, La Paz University Hospital, 28046 Madrid, Spain; (A.R.); (A.G.)
| | - Alejandro Gallego
- Department of Medical Oncology, La Paz University Hospital, 28046 Madrid, Spain; (A.R.); (A.G.)
| | - Alicia Hernández
- Department of Gynecology, La Paz University Hospital, 28046 Madrid, Spain; (E.S.); (M.C.); (A.L.-C.); (A.H.)
- Research Institute “IdiPaz”, La Paz University Hospital, 28046 Madrid, Spain
- Department of Obstetrics and Gynaecology, Universidad Autónoma Madrid, 28049 Madrid, Spain
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Kisovar A, Becker CM, Granne I, Southcombe JH. The role of CD8+ T cells in endometriosis: a systematic review. Front Immunol 2023; 14:1225639. [PMID: 37497226 PMCID: PMC10366819 DOI: 10.3389/fimmu.2023.1225639] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 06/26/2023] [Indexed: 07/28/2023] Open
Abstract
Background Endometriosis is a chronic disease affecting 6-10% of women of reproductive age. It is an important cause of infertility and chronic pelvic pain with poorly understood aetiology. CD8+ T (CD8 T) cells were shown to be linked to infertility and chronic pain and play a significant role in lesion clearance in other pathologies, yet their function in endometriosis is unknown. We systematically evaluated the literature on the CD8 T in peripheral blood and endometriosis-associated tissues to determine the current understanding of their pathophysiological and clinical relevance in the disease and associated conditions (e.g. infertility and pelvic pain). Methods Four databases were searched (MEDLINE, EMBASE, Web of Science, CINAHL), from database inception until September 2022, for papers written in the English language with database-specific relevant terms/free-text terms from two categories: CD8 T cells and endometriosis. We included peer-reviewed papers investigating CD8 T cells in peripheral blood and endometriosis-associated tissues of patients with surgically confirmed endometriosis between menarche and menopause, and animal models with oestrous cycles. Studies enrolling participants with other gynaecological pathologies (except uterine fibroids and tubal factor infertility used as controls), cancer, immune diseases, or taking immune or hormonal therapy were excluded. Results 28 published case-control studies and gene set analyses investigating CD8 T cells in endometriosis were included. Data consistently indicate that CD8 T cells are enriched in endometriotic lesions in comparison to eutopic endometrium, with no differences in peripheral blood CD8 T populations between patients and healthy controls. Evidence on CD8 T cells in peritoneal fluid and eutopic endometrium is conflicting. CD8 T cell cytotoxicity was increased in the menstrual effluent of patients, and genomic analyses have shown a clear trend of enriched CD8 T effector memory cells in the eutopic endometrium of patients. Conclusion Literature on CD8 T cells in endometriosis-associated tissues is inconsistent. Increased CD8 T levels are found in endometriotic lesions, however, their activation potential is understudied in all relevant tissues. Future research should focus on identifying clinically relevant phenotypes to support the development of non-invasive diagnostic and treatment strategies. Systematic Review Registration PROSPERO identifier CRD42021233304.
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Affiliation(s)
| | | | | | - Jennifer H. Southcombe
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, United Kingdom
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Kang JH, Lee KA, Heo YR, Kim WY, Paik ES. Efficacy of a continuous wound infiltration system for postoperative pain management in gynecologic patients who underwent single-port access laparoscopy for adnexal disease. Front Med (Lausanne) 2023; 10:1199428. [PMID: 37476613 PMCID: PMC10354268 DOI: 10.3389/fmed.2023.1199428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/19/2023] [Indexed: 07/22/2023] Open
Abstract
Introduction Single-port access (SPA) laparoscopy requires only one incision, unlike conventional laparoscopy. However, its umbilical incision is larger than that of conventional laparoscopy and can be vulnerable to postoperative pain. This study aimed to evaluate whether simultaneous use of a continuous wound infiltration (CWI) system and intravenous patient-controlled analgesia (IV PCA) effectively decreases surgical site pain in patients who underwent SPA laparoscopy due to gynecologic adnexal disease. Methods A total of 371 patients who underwent SPA laparoscopy and who received IV PCA or CWI was retrospectively reviewed (combined group [CWI + IV PCA, n = 159] vs. PCA group [IV PCA only, n = 212]). To evaluate postoperative pain management, the numeric rating scale (NRS) pain score after surgery, total amount of fentanyl administered via IV PCA, and additional pain killer consumption were collected. Results The NRS scores at 12 h (1.90 ± 1.11 vs. 2.70 ± 1.08, p < 0.001) and 24 h (1.82 ± 0.82 vs. 2.11 ± 1.44, p = 0.026) after surgery were significantly lower in the combined group than in the PCA group. The total amount of PCA fentanyl was significantly smaller in the combined group than in the PCA group (p < 0.001). The total quantity of rescue analgesics was smaller in the combined group than in the PCA group (p < 0.05). Conclusion Combined use of the CWI system and IV PCA is an effective postoperative pain management strategy in patient who underwent SPA laparoscopy for adnexal disease.
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Affiliation(s)
- Jun-Hyeok Kang
- Department of Obstetrics and Gynecology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Republic of Korea
| | - Kyung A Lee
- Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yae Rin Heo
- Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Woo Young Kim
- Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - E Sun Paik
- Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Maclean A, Barzilova V, Patel S, Bates F, Hapangama DK. Characterising the immune cell phenotype of ectopic adenomyosis lesions compared with eutopic endometrium: A systematic review. J Reprod Immunol 2023; 157:103925. [PMID: 36870297 DOI: 10.1016/j.jri.2023.103925] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/16/2023] [Accepted: 02/28/2023] [Indexed: 03/05/2023]
Abstract
Inflammation is implicated in the symptomatology and the pathogenesis of adenomyosis. Injury at the endo-myometrial interface causes inflammation and may facilitate the invasion of endometrium into the myometrium, forming adenomyosis lesions. Their presence causes local inflammation, resulting in heavy menstrual bleeding, chronic pelvic pain, and subfertility. Immunological differences have been described in the eutopic endometrium from women with adenomyosis compared to healthy endometrium, and differences are also expected in the adenomyotic lesions compared with the correctly sited eutopic endometrium. This systematic review retrieved relevant articles from three databases with additional manual citation chaining from inception to 24th October 2022. Twenty-two eligible studies were selected in accordance with PRISMA guidelines. Risk of bias assessments were performed, and the findings presented thematically. Ectopic endometrial stroma contained an increased density of macrophages compared with eutopic endometrium in adenomyosis. This was associated with an increase in pro-inflammatory cytokines (IL-6, IL-8, ILβ-1, C-X-C Motif Chemokine Receptor 1(CXCR1), Monocyte Chemoattractant Protein-1 (MCP-1)), and an imbalance of anti-inflammatory cytokines (IL-22, IL-37). Cells in ectopic lesions also contained a higher levels of toll-like receptors and immune-mediated enzymes. However, the studies were heterogeneous, with inconsistent reporting of immune cell density within epithelial or stromal compartments, and inclusion of samples from different menstrual cycle phases in the same group for analysis. A detailed understanding of the immune cell phenotypes present in eutopic and ectopic endometrium in adenomyosis and associated dysregulated inflammatory processes will provide further insight into the pathogenesis, to enable identification of fertility-sparing treatments as an alternative to hysterectomy.
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Affiliation(s)
- Alison Maclean
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L8 7SS, United Kingdom; Liverpool Women's Hospital NHS Foundation Trust, Member of Liverpool Health Partners, Liverpool L8 7SS, United Kingdom.
| | - Vanya Barzilova
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L8 7SS, United Kingdom
| | - Simran Patel
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L8 7SS, United Kingdom
| | - Faith Bates
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L8 7SS, United Kingdom; School of Life Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 7ZB, United Kingdom
| | - Dharani K Hapangama
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L8 7SS, United Kingdom; Liverpool Women's Hospital NHS Foundation Trust, Member of Liverpool Health Partners, Liverpool L8 7SS, United Kingdom
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8
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Liu W, Sheng S, Zhu C, Li C, Zou Y, Yang C, Chen ZJ, Wang F, Jiao X. Increased NKG2A +CD8 + T-cell exhaustion in patients with adenomyosis. Mucosal Immunol 2023; 16:121-134. [PMID: 36828189 DOI: 10.1016/j.mucimm.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/30/2023] [Accepted: 02/12/2023] [Indexed: 02/24/2023]
Abstract
Immune dysregulation has long been proposed to be associated with adenomyosis, but the underlying mediators and mechanisms remain largely unexplored. Here, we used flow cytometry to investigate the alterations in immune cell subsets in adenomyotic uteri and analyze the phenotype and function of abnormal immune cells. We found that an increase in cluster of differentiation (CD)8+ T-cell number was the predominant alteration in ectopic lesions in patients with adenomyosis and was significantly associated with the severity of adenomyosis. Importantly, we identified an exhausted natural killer group protein 2A (NKG2A)+CD8+ T-cell subset that was associated with the severity of adenomyosis and found that the number of these cells was significantly increased in the eutopic endometrium and ectopic lesions. In addition, the increases in the expression of NKG2A ligand histocompatibility leucocyte antigen E and interleukin-15 in glandular epithelial cells in the adenomyotic microenvironment might contribute to CD8+ T-cell exhaustion by promoting NKG2A expression on CD8+ T cells or inhibiting the effector function of these cells. In conclusion, our data revealed a previously unrecognized role for NKG2A+CD8+ T-cell exhaustion in the pathogenesis of adenomyosis, indicating that therapeutic interventions designed to target and reinvigorate exhausted CD8+ T cells may be beneficial for patients with adenomyosis.
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Affiliation(s)
- Wei Liu
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital, Shandong University, Jinan, China; Department of Obstetrics and Gynecology, Shandong Provincial Hospital, Affiliated to Shandong First Medical University, Jinan, China
| | - Shuman Sheng
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital, Affiliated to Shandong First Medical University, Jinan, China
| | - Chendi Zhu
- Center for Reproductive Medicine, Shandong University, Jinan, China; Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China; Shandong Key Laboratory of Reproductive Medicine, Jinan, China; Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, China; Shandong Technology Innovation Center for Reproductive Health, Jinan, China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
| | - Changzhong Li
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital, Shandong University, Jinan, China; Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Yonghui Zou
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital, Shandong University, Jinan, China; Department of Obstetrics and Gynecology, Shandong Provincial Hospital, Affiliated to Shandong First Medical University, Jinan, China
| | - Chunrun Yang
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital, Shandong University, Jinan, China; Department of Obstetrics and Gynecology, Shandong Provincial Hospital, Affiliated to Shandong First Medical University, Jinan, China
| | - Zi-Jiang Chen
- Center for Reproductive Medicine, Shandong University, Jinan, China; Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China; Shandong Key Laboratory of Reproductive Medicine, Jinan, China; Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, China; Shandong Technology Innovation Center for Reproductive Health, Jinan, China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
| | - Fei Wang
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital, Shandong University, Jinan, China; Department of Obstetrics and Gynecology, Shandong Provincial Hospital, Affiliated to Shandong First Medical University, Jinan, China; Shandong Key Laboratory of Reproductive Medicine, Jinan, China.
| | - Xue Jiao
- Center for Reproductive Medicine, Shandong University, Jinan, China; Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China; Shandong Key Laboratory of Reproductive Medicine, Jinan, China; Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, China; Shandong Technology Innovation Center for Reproductive Health, Jinan, China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China; Suzhou Institute of Shandong University, Suzhou, China.
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9
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Chen S, Liu Y, Zhong Z, Wei C, Liu Y, Zhu X. Peritoneal immune microenvironment of endometriosis: Role and therapeutic perspectives. Front Immunol 2023; 14:1134663. [PMID: 36865552 PMCID: PMC9971222 DOI: 10.3389/fimmu.2023.1134663] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/01/2023] [Indexed: 02/16/2023] Open
Abstract
Endometriosis, an estrogen-dependent chronic inflammatory disease characterized by the growth of endometrium-like tissues outside the uterine cavity, affects 10% of reproductive-age women. Although the pathogenesis of endometriosis is uncertain, it is widely accepted that retrograde menstruation results in ectopic endometrial tissue implantation. Given that not all women with retrograde menstruation develop endometriosis, immune factors have been hypothesized to affect the pathogenesis of endometriosis. In this review, we demonstrate that the peritoneal immune microenvironment, including innate immunity and adaptive immunity, plays a central role in the pathogenesis of endometriosis. Current evidence supports the fact that immune cells, such as macrophages, natural killer (NK) cells, dendritic cells (DCs), neutrophils, T cells, and B cells, as well as cytokines and inflammatory mediators, contribute to the vascularization and fibrogenesis of endometriotic lesions, accelerating the implantation and development of ectopic endometrial lesions. Endocrine system dysfunction influences the immune microenvironment through overexpressed estrogen and progesterone resistance. In light of the limitations of hormonal therapy, we describe the prospects for potential diagnostic biomarkers and nonhormonal therapy based on the regulation of the immune microenvironment. Further studies are warranted to explore the available diagnostic biomarkers and immunological therapeutic strategies for endometriosis.
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Affiliation(s)
- Siman Chen
- Laboratory for Reproductive Immunology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China
| | - Yukai Liu
- Laboratory for Reproductive Immunology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China
| | - Zhiqi Zhong
- Xinglin College, Nantong University, Nantong, Jiangsu, China
| | - Chunyan Wei
- Laboratory for Reproductive Immunology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China
| | - Yuyin Liu
- Department of Gynecology and Obstetrics, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaoyong Zhu
- Laboratory for Reproductive Immunology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China,Key Laboratory of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, Shanghai, China,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Fudan University, Shanghai, China,*Correspondence: Xiaoyong Zhu,
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10
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Han MT, Cheng W, Zhu R, Wu HH, Ding J, Zhao NN, Li H, Wang FX. The cytokine profiles in follicular fluid and reproductive outcomes in women with endometriosis. Am J Reprod Immunol 2022; 89:e13633. [PMID: 36250899 DOI: 10.1111/aji.13633] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 09/01/2022] [Accepted: 10/03/2022] [Indexed: 11/26/2022] Open
Abstract
PROBLEM Endometriosis patients undergoing in vitro fertilization-embryo transfer (IVF-ET) treatment suffer from poor oocyte quality, a reduced likelihood of the fertilization rate, and low embryo quality. The dysregulation of immune cells and cytokine profiles in the follicular fluid (FF) may play an important role in the competence of the oocyte and the development of the embryo, but the mechanism remains largely unknown. METHOD OF STUDY A total of 40 proved advanced staged endometriosis patients were enrolled in this study. The pregnancy results were followed until all the embryos collected by the first oocyte retrieval cycle were used up. The immune cells subtypes in FF and serum collected on the day of oocyte retrieval were detected by flow cytometry and 27 cytokines were determined using the Bio-Plex Pro Human Cytokine 27-Plex Immunoassay. The specific effect of cytokine on the gene expression of human granulosa cells was determined by RT-qPCR. RESULTS The fertilization rate and the cumulative live birth rate were significantly lower in the endometriosis group. The ratio of CD4+ /CD8+ T cells in FF was significantly lower, while the level of IP-10, RANTES and G-CSF were statistically higher in the endometriosis group. The level of IP-10 correlated with the IVF outcome. Moreover, treated by IP-10, the mRNA level of FSHR and CYP19A1 the human granulosa cells were downregulated in vitro. CONCLUSION These results suggest that alterations of the lymphocyte subsets and cytokines in women with advanced endometriosis may have an impact on the oocyte development and resulting in poorer IVF outcomes.
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Affiliation(s)
- Mu-Tian Han
- Center of Human Reproduction and Genetics, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, China.,Department of Immunology, Anhui medical university, Hefei, China
| | - Wei Cheng
- Center of Human Reproduction and Genetics, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, China
| | - Rui Zhu
- Center of Human Reproduction and Genetics, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, China
| | - Hui-Hua Wu
- Center of Human Reproduction and Genetics, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, China
| | - Jie Ding
- Center of Human Reproduction and Genetics, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, China
| | - Nan-Nan Zhao
- Center of Human Reproduction and Genetics, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, China
| | - Hong Li
- Center of Human Reproduction and Genetics, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, China
| | - Fu-Xin Wang
- Center of Human Reproduction and Genetics, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, China
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11
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Liu M, Yan J, Wu Y, Zhu H, Huang Y, Wu K. The impact of herbal medicine in regulating intestinal flora on female reproductive disorders. Front Pharmacol 2022; 13:1026141. [PMID: 36313343 PMCID: PMC9614049 DOI: 10.3389/fphar.2022.1026141] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/03/2022] [Indexed: 11/13/2022] Open
Abstract
As an important part of the human intestinal microecology, the intestinal flora is involved in a number of physiological functions of the host. Several studies have shown that imbalance of intestinal flora and its regulation of the intestinal barrier, intestinal immune response, and intestinal flora metabolites (short-chain fatty acids and bile acids) can affect the development and regression of female reproductive disorders. Herbal medicine has unique advantages in the treatment of female reproductive disorders such as polycystic ovary syndrome, endometriosis and premature ovarian insufficiency, although its mechanism of action is still unclear. Therefore, based on the role of intestinal flora in the occurrence and development of female reproduction-related diseases, the progress of research on the diversity, structure and composition of intestinal flora and its metabolites regulated by botanical drugs, Chinese herbal formulas and active ingredients of Chinese herbal medicines is reviewed, with a view to providing reference for the research on the mechanism of action of Chinese herbal medicines in the treatment of female reproductive disorders and further development of new herbal medicines.
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Affiliation(s)
- Min Liu
- Department of Gynecology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Jin Yan
- Department of Gynecology, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Yeke Wu
- Department of Stomatology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Hongqiu Zhu
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yefang Huang
- Department of Gynecology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- *Correspondence: Yefang Huang, ; Keming Wu,
| | - Keming Wu
- Department of Gynecology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- *Correspondence: Yefang Huang, ; Keming Wu,
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12
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Xiaocui L, Wei H, Yunlang C, Zhenzhen Z, Min A. CSF-1-induced DC-SIGN + macrophages are present in the ovarian endometriosis. Reprod Biol Endocrinol 2022; 20:48. [PMID: 35260161 PMCID: PMC8903642 DOI: 10.1186/s12958-022-00901-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 01/25/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Researchers have found that macrophages are the predominant cells in the peritoneal fluid (PF) of endometriosis patients. CSF-1 has been found to accumulate in the lesions and PF of endometriosis patients, and CSF-1 induces THP-1-derived macrophages to polarize toward a CD169+ DC-SIGN+ phenotype. Does the cytokine CSF-1 induce monocytes to differentiate into macrophages with a DC-SIGN+ phenotype in endometriosis? METHODS The level of CSF-1 in the endometrium of control subjects, and the eutopic, and ectopic endometrium of endometriosis patients was evaluated by real-time polymerase chain reaction (qRT-PCR) and was determined by enzyme-linked immunosorbent assay (ELISA) in the PF of control and endometriosis patients. CSF-1 expression was examined with a MILLIPLEX MAP Mouse Cytokine/Chemokine Magnetic Bead Panel. DC-SIGN+ macrophages were detected by immunohistochemical staining of tissues and flow cytometric analysis of the PF of control subjects (N = 25) and endometriosis (N = 35) patients. The phenotypes and biological activities of CSF-1 -induced macrophages were compared in an in vitro coculture system with peripheral blood lymphocytes from control subjects. RESULTS In this study, we found that the proportion of DC-SIGN+ CD169+ macrophages was higher in the abdominal immune microenvironment of endometriosis patients. CSF-1 was primarily secreted from ectopic lesions and peritoneum in mice with endometriosis. In addition, CSF-1 induced the polarization of macrophages toward a DC-SIGN+ CD169+ phenotype; this effect was abolished by the addition of an anti-CSF-1R antibody. CSF-1 induced the generation of DC-SIGN+ macrophages, leading to a depressed status of peripheral blood lymphocytes, including a high percentage of Treg cells and a low percentage of CD8+ T cells. Similarly, blockade with the anti-CSF-1R antibody abrogated this biological effect. CONCLUSIONS This is the first study on the role of DC-SIGN+ macrophages in the immune microenvironment of endometriosis. Further study of the mechanism and biological activities of CSF-1-induced DC-SIGN+ macrophages will enhance our understanding of the physiology of endometriosis.
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Affiliation(s)
- Li Xiaocui
- Department of Obstetrics and Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, 201204, P.R. China
| | - Hong Wei
- Department of Obstetrics and Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, 201204, P.R. China
| | - Cai Yunlang
- Department of Obstetrics and Gynecology, Medical School, Zhongda Hospital, Southeast University, Nanjing, 210009, China
| | - Zheng Zhenzhen
- Department of Obstetrics and Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, 201204, P.R. China
| | - An Min
- Department of Obstetrics and Gynecology, Medical School, Zhongda Hospital, Southeast University, Nanjing, 210009, China.
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13
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Deep Infiltrating Endometriosis and Adenomyosis: Implications on Pregnancy and Outcome. J Clin Med 2021; 11:jcm11010157. [PMID: 35011898 PMCID: PMC8745136 DOI: 10.3390/jcm11010157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/16/2021] [Accepted: 12/24/2021] [Indexed: 11/17/2022] Open
Abstract
Endometriosis (EM), especially deep infiltrating endometriosis (DIE) and adenomyosis (AM), are known to cause pain and sterility in young women. More recently, they have also been described as risk factors for obstetric complications. While the pathophysiology is not yet completely understood, they seem to share a common origin: archimetrosis. Methods: A systematic literature review was conducted to summarize the existing evidence on DIE and AM as risk factors for obstetric complications. Results: Preterm birth, caesarean section delivery (CS) and placental abnormalities are associated with the diagnosis of DIE and AM. Women with AM seem to experience more often hypertensive pregnancy disorders, premature rupture of membranes and their children are born with lower birth weights than in the control groups. However, many of the studies tried to evaluate AM, EM and DIE as separate risk factors. Moreover, often they did not adjust for important confounders such as multiple pregnancies, parity, mode of conception and maternal age. Therefore, prospective studies with larger numbers of cases and appropriate adjustment for confounders are needed to explore the pathophysiology and to prove causality.
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14
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The Role of Selected Chemokines in the Peritoneal Fluid of Women with Endometriosis—Participation in the Pathogenesis of the Disease. Processes (Basel) 2021. [DOI: 10.3390/pr9122229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Endometriosis is a disorder characterized by the presence of endometrial tissue outside the uterine cavity, primarily into the peritoneal cavity. It is known as a complex, chronic inflammatory disease and it is strongly associated with immune dysregulation. Various soluble mediators of the immune and inflammatory responses, including chemokines, play an important role in these processes. The aim of the study was to understand the role of the chemokines MCP-1, MCP-2, MCP-3, MCP-4, MIP-1 α, MIP-1β, eotaxin 2, eotaxin 3, ENA-78, and fractalkine in the development of endometriosis through their assessment in the peritoneal fluid of women with endometriosis. The study group included 58 women with endometriosis who were diagnosed during laparoscopy and then confirmed by histopathology. In 15 women from the reference group, laparoscopic examination demonstrated a normal status of the pelvic organs without any evidence of endometriosis nor inflammation in the peritoneal cavity. The peritoneal fluid of women with endometriosis and of women from the reference group were examined. To determine the concentration of the studied chemokines, enzyme immunoassays for Luminex® platforms were used. In the peritoneal fluid of women with endometriosis, a statistically significant increase in the concentration of MIP-1β, eotaxin 2, eotaxin 3, ENA-78, and fractalkine and a decrease in the concentration of MCP-1, MCP-2, MCP-3, MCP-4, and MIP-1α were observed compared to the reference group. The concentration of these cytokines depended on the severity of the disease. Changes in the concentration of the studied chemokines in the peritoneal fluid of women with endometriosis suggest their participation in the pathogenesis of the disease. The differences in chemokines concentration observed in different stages of endometriosis may be associated with the presence of inflammation in the peritoneal cavity at each step of disease development.
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15
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Sun SG, Guo JJ, Qu XY, Tang XY, Lin YY, Hua KQ, Qiu JJ. The extracellular vesicular pseudogene LGMNP1 induces M2-like macrophage polarization by upregulating LGMN and serves as a novel promising predictive biomarker for ovarian endometriosis recurrence. Hum Reprod 2021; 37:447-465. [PMID: 34893848 DOI: 10.1093/humrep/deab266] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 11/02/2021] [Indexed: 12/15/2022] Open
Abstract
STUDY QUESTION How does ectopic endometrial stromal cell (Ecto-ESC)-derived extracellular vesicular Legumain pseudogene 1 (EV-LGMNP1), a newly identified pseudogene of Legumain (LGMN), contribute to M2-phenotype macrophage polarization, and does it predict recurrence in patients with ovarian endometriosis (EMs)? SUMMARY ANSWER EV-LGMNP1, which is abundant in Ecto-ESCs and serum from ovarian EMs, can direct macrophages towards an M2 phenotype by upregulating LGMN expression and is a promising biomarker for predicting ovarian EMs recurrence. WHAT IS KNOWN ALREADY Extracellular vesicles (EVs) can mediate cell-to-cell crosstalk to promote disease progression via cargo molecule transport. Recently, LGMNP1, a newly identified pseudogene of LGMN, has been reported to promote cancer progression by upregulating LGMN. LGMN is a well-studied protein that can induce M2-like polarization. STUDY DESIGN, SIZE, DURATION An in vitro study was conducted with Ecto-ESCs isolated from ectopic endometrial samples, collected from two patients with ovarian EMs (diagnosed by laparoscopy and histological analysis). A clinical retrospective cohort study of 52 ovarian EMs patients and 21 controls with available preoperative serum samples was carried out (2013-2017). The follow-up period ended either at the time of recurrence or on 31 December 2018. PARTICIPANTS/MATERIALS, SETTING, METHODS Ecto-ESC-derived EVs (EV/Ecto-ESCs) were characterized by nanoparticle tracking analysis, transmission electron microscopy and western blotting. EV internalization by THP-1 cells, which are the most widely used primary human macrophages model, was detected by fluorescence labelling. After EV treatment, THP-1 cell polarization was detected by quantitative real-time PCR (qRT-PCR) and western blot analyses of CD86 (M1-related marker) and CD206 (M2-related marker). LGMNP1 mRNA expression level in EVs from both primary ectopic endometrioc stromal cells and serum was examined using qRT-PCR. Additionally, the expression of LGMN, the downstream target gene of LGMNP1, in THP-1 cells was evaluated using qRT-PCR and western blotting. Kaplan-Meier and multivariate Cox regression analyses were applied to evaluate the independent predictive factors of EMs recurrence-free survival. A novel nomogram model based on serum EV-LGMNP1 was then formulated to predict EMs recurrence. MAIN RESULTS AND THE ROLE OF CHANCE In vitro assays demonstrated that EV/Ecto-ESCs drove macrophages towards an M2-like phenotype. Moreover, LGMNP1 contributed to EV/Ecto-ESC-induced M2 macrophage polarization by upregulating LGMN mRNA expression levels. Clinically, serum EV-LGMNP1 was more highly expressed in recurrent EMs patients than in controls and EMs patients without recurrence. Survival analysis and our novel nomogram reconfirmed that serum EV-LGMNP1 was a novel promising and meaningful non-invasive biomarker for predicting EMs recurrence. LARGE SCALE DATA N/A. LIMITATIONS, REASONS FOR CAUTION In vitro experiments were only performed on samples from two patients with ovarian endometriosis, and a larger sample size is needed. ESCs isolated from the eutopic endometrium of EMs and non-EMs patients should be studied in the future. Additionally, in vitro experiments should be performed using endometrial epithelium cells and further in vivo experiments, such as using mice endometriotic models to investigate whether EV/Ecto could induce M2 macrophage polarization, should be conducted. Moreover, multicentre, large-sample data are needed to validate our predictive nomogram model. WIDER IMPLICATIONS OF THE FINDINGS Our study provides novel insights into the mechanism of M2 polarization involved in ovarian EMs progression mediated by an 'EV-shuttled pseudogene LGMNP1' mode. In addition, serum EV-LGMNP1 may serve as a novel non-invasive biomarker for predicting recurrence, providing a new therapeutic target for ovarian EMs. STUDY FUNDING/COMPETING INTEREST(S) This project was supported by funding from the National Natural Science Foundation of China (81971361), the Natural Science Foundation of Shanghai Science and Technology (19ZR1406900), the Shanghai 'Rising Stars of Medical Talent' Youth Development Program (AB83030002019004), the Clinical Research Plan of SHDC (SHDC2020CR4087), the Shanghai Municipal Health Commission (202040498), the Research and Innovation Project of the Shanghai Municipal Education Commission (2019-01-07-00-07-E00050) and the Clinical Research Plan of SHDC (SHDC2020CR1045B). There are no competing interests to declare.
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Affiliation(s)
- S G Sun
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - J J Guo
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - X Y Qu
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - X Y Tang
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Y Y Lin
- Department of Neurosurgery, Ren Ji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - K Q Hua
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - J J Qiu
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
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16
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Meligy FY, Elgamal DA, Abdelzaher LA, Khashbah MY, El-Mokhtar MA, Sayed AA, Refaiy AM, Othman ER. Adipose tissue-derived mesenchymal stem cells reduce endometriosis cellular proliferation through their anti-inflammatory effects. Clin Exp Reprod Med 2021; 48:322-336. [PMID: 34875740 PMCID: PMC8651762 DOI: 10.5653/cerm.2021.04357] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 06/23/2021] [Indexed: 12/29/2022] Open
Abstract
Objective Endometriosis is a chronic debilitating inflammatory condition characterized by the presence of endometrial tissues outside the uterine cavity. Pelvic soreness and infertility are the usual association. Due to the poor effectiveness of the hormone therapy and the high incidence of recurrence following surgical excision, there is no single effective option for management of endometriosis. Mesenchymal stem cells (MSCs) are multipotent stromal cells studied for their broad immunoregulatory and anti-inflammatory properties; however, their efficiency in endometriosis cases is still a controversial issue. Our study aim was to evaluate whether adipose tissue-derived MSCs (AD-MSCs) could help with endometriosis through their studied anti-inflammatory role. Methods Female Wistar rats weighting 180 to 250 g were randomly divided into two groups: group 1, endometriosis group; established by transplanting autologous uterine tissue into rats’ peritoneal cavities and group 2, stem cell treated group; treated with AD-MSCs on the 5th day after induction of endometriosis. The proliferative activity of the endometriosis lesions was evaluated through Ki67 staining. Quantitative estimation of interferon γ, tumor necrosis factor-α, interleukin (IL)-6, IL-1β, IL-10, and transforming growth factor β expression, as well as immunohistochemical detection of CD68 positive macrophages, were used to assess the inflammatory status. Results The size and proliferative activity of endometriosis lesions were significantly reduced in the stem cell treated group. Stem cells efficiently mitigated endometriosis associated chronic inflammatory reactions estimated through reduction of CD68 positive macrophages and the expression of the proinflammatory cytokines. Conclusion Stem cell therapy can be considered a novel remedy in endometriosis possibly through its anti-inflammatory and antiproliferative properties.
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Affiliation(s)
- Fatma Y Meligy
- Department of Histology and Cell Biology, Faculty of Medicine, Assiut University, Assiut, Egypt.,Reproductive Science Research Center, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Dalia A Elgamal
- Department of Histology and Cell Biology, Faculty of Medicine, Assiut University, Assiut, Egypt.,Reproductive Science Research Center, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Lobna A Abdelzaher
- Reproductive Science Research Center, Faculty of Medicine, Assiut University, Assiut, Egypt.,Department of Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Maha Y Khashbah
- Reproductive Science Research Center, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohamed A El-Mokhtar
- Reproductive Science Research Center, Faculty of Medicine, Assiut University, Assiut, Egypt.,Department of Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ayat A Sayed
- Reproductive Science Research Center, Faculty of Medicine, Assiut University, Assiut, Egypt.,Department of Biochemistry, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Abeer M Refaiy
- Reproductive Science Research Center, Faculty of Medicine, Assiut University, Assiut, Egypt.,Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Essam R Othman
- Reproductive Science Research Center, Faculty of Medicine, Assiut University, Assiut, Egypt.,Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
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17
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Velho RV, Taube E, Sehouli J, Mechsner S. Neurogenic Inflammation in the Context of Endometriosis-What Do We Know? Int J Mol Sci 2021; 22:ijms222313102. [PMID: 34884907 PMCID: PMC8658724 DOI: 10.3390/ijms222313102] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/26/2021] [Accepted: 12/01/2021] [Indexed: 12/25/2022] Open
Abstract
Endometriosis (EM) is an estrogen-dependent disease characterized by the presence of epithelial, stromal, and smooth muscle cells outside the uterine cavity. It is a chronic and debilitating condition affecting ~10% of women. EM is characterized by infertility and pain, such as dysmenorrhea, chronic pelvic pain, dyspareunia, dysuria, and dyschezia. Although EM was first described in 1860, its aetiology and pathogenesis remain uncertain. Recent evidence demonstrates that the peripheral nervous system plays an important role in the pathophysiology of this disease. Sensory nerves, which surround and innervate endometriotic lesions, not only drive the chronic and debilitating pain associated with EM but also contribute to a growth phenotype by secreting neurotrophic factors and interacting with surrounding immune cells. Here we review the role that peripheral nerves play in driving and maintaining endometriotic lesions. A better understanding of the role of this system, as well as its interactions with immune cells, will unearth novel disease-relevant pathways and targets, providing new therapeutics and better-tailored treatment options.
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Affiliation(s)
- Renata Voltolini Velho
- Department of Gynecology Charité with Center of Oncological Surgery, Endometriosis Research Center Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany; (R.V.V.); (J.S.)
| | - Eliane Taube
- Institute of Pathology, Charité Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany;
| | - Jalid Sehouli
- Department of Gynecology Charité with Center of Oncological Surgery, Endometriosis Research Center Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany; (R.V.V.); (J.S.)
| | - Sylvia Mechsner
- Department of Gynecology Charité with Center of Oncological Surgery, Endometriosis Research Center Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany; (R.V.V.); (J.S.)
- Correspondence: ; Tel.: +49-030-450664866
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18
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Nero C, Romito I, Spadola S, Romito A, Turco LC, Cosentino F, De Ninno M, Catena U, De Cicco Nardone A, Moroni R, Zannoni G, Fagotti A, Scambia G. Infiltrating T lymphocytes and programmed cell death protein-1/programmed death-ligand 1 expression in endometriosis-associated ovarian cancer. Fertil Steril 2021; 117:160-168. [PMID: 34656305 DOI: 10.1016/j.fertnstert.2021.08.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/15/2021] [Accepted: 08/19/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To characterize T lymphocyte infiltration and programmed cell death protein-1 (PD-1)/programmed death-ligand 1 (PD-L1) expression in early-stage endometriosis-associated ovarian cancer (EAOC), ovarian endometriosis (OE), atypical endometriosis (AE), and deep endometriosis (DE). DESIGN Case-control, retrospective study. SETTING Research University Hospital. PATIENT(S) A total of 362 patients with a histologic diagnosis of EAOC, OE, AE, or DE were identified between 2000 and 2019 from Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Gemelli Molise SpA tissue data banks. A 1:1 propensity score-matched method yielded matched pairs of 55 subjects with EAOC, 55 patients with OE, 12 patients with AE, and 42 patients with DE, resulting in no differences in family history of cancer, parity, and use of oral contraceptives. INTERVENTION(S) Immunohistochemistry assays using the following primary antibodies: CD3+; CD4+; CD8+; PD-1; and PD-L1. MAIN OUTCOME MEASURE(S) To characterize T lymphocyte infiltration and PD-1/PD-L1 expression in 4 different endometriosis-related diseases. RESULT(S) Endometriosis-associated ovarian cancer cases displayed significantly higher levels of PD-1/PD-L1 expression compared with all other endometriosis-related diseases (vs. OE vs. AE vs. DE). Moreover, a significantly lower count of infiltrating T lymphocytes was observed in EAOC cases compared with OE ones. Finally, one-third of OE cases showed a cancer-like PD-1/PD-L1 expression profile. CONCLUSION(S) Endometriosis-associated ovarian cancer is characterized by higher levels of PD-1/PD-L1 expression compared with benign endometriosis-related diseases. This profile was found in one-third of clinically benign cases, suggesting that it develops early in the carcinogenesis process.
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Affiliation(s)
- Camilla Nero
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Dipartimento per le Scienze della salute della donna, del bambino e di Sanità Pubblica, Roma, Italia; Università Cattolica del Sacro Cuore, Roma, Italia.
| | | | - Saveria Spadola
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Dipartimento per le Scienze della salute della donna, del bambino e di Sanità Pubblica, Roma, Italia
| | | | - Luigi Carlo Turco
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Dipartimento per le Scienze della salute della donna, del bambino e di Sanità Pubblica, Roma, Italia
| | | | - Maria De Ninno
- Gynecologic Oncology Division, Gemelli Molise SpA, Campobasso, Italia
| | - Ursula Catena
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Dipartimento per le Scienze della salute della donna, del bambino e di Sanità Pubblica, Roma, Italia
| | - Alessandra De Cicco Nardone
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Dipartimento per le Scienze della salute della donna, del bambino e di Sanità Pubblica, Roma, Italia
| | - Rossana Moroni
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Dipartimento per le Scienze della salute della donna, del bambino e di Sanità Pubblica, Roma, Italia
| | - Gianfranco Zannoni
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Dipartimento per le Scienze della salute della donna, del bambino e di Sanità Pubblica, Roma, Italia; Università Cattolica del Sacro Cuore, Roma, Italia
| | - Anna Fagotti
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Dipartimento per le Scienze della salute della donna, del bambino e di Sanità Pubblica, Roma, Italia; Università Cattolica del Sacro Cuore, Roma, Italia
| | - Giovanni Scambia
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Dipartimento per le Scienze della salute della donna, del bambino e di Sanità Pubblica, Roma, Italia; Università Cattolica del Sacro Cuore, Roma, Italia
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19
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Donnez J, Stratopoulou CA, Dolmans MM. Uterine Adenomyosis: From Disease Pathogenesis to a New Medical Approach Using GnRH Antagonists. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18199941. [PMID: 34639243 PMCID: PMC8508387 DOI: 10.3390/ijerph18199941] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 12/24/2022]
Abstract
Uterine adenomyosis is a common chronic disorder frequently encountered in reproductive-age women, causing heavy menstrual bleeding, intense pelvic pain, and infertility. Despite its high prevalence, its etiopathogenesis is not yet fully understood, so there are currently no specific drugs to treat the disease. A number of dysregulated mechanisms are believed to contribute to adenomyosis development and symptoms, including sex steroid signaling, endometrial proliferation and invasiveness, and aberrant immune response. Abnormal sex steroid signaling, particularly hyperestrogenism and subsequent progesterone resistance, are known to play a pivotal role in its pathogenesis, which is why various antiestrogenic agents have been used to manage adenomyosis-related symptoms. Among them, gonadotropin-releasing hormone (GnRH) antagonists are swiftly gaining ground, with recent studies reporting efficient lesion regression and symptom alleviation. The aim of the present review is to compile available information on the pathogenesis of adenomyosis, explore the etiology and mechanisms of hyperestrogenism, and discuss the potential of antiestrogenic therapies for treating the disease and improving patient quality of life.
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Affiliation(s)
- Jacques Donnez
- Société de Recherche Pour l’Infertilité, 1150 Brussels, Belgium
- Université Catholique de Louvain, 1200 Brussels, Belgium
- Correspondence:
| | - Christina Anna Stratopoulou
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1200 Brussels, Belgium; (C.A.S.); (M.-M.D.)
| | - Marie-Madeleine Dolmans
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1200 Brussels, Belgium; (C.A.S.); (M.-M.D.)
- Gynecology Department, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
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20
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The Role of Abnormal Uterine Junction Zone in the Occurrence and Development of Adenomyosis. Reprod Sci 2021; 29:2719-2730. [PMID: 34515984 DOI: 10.1007/s43032-021-00684-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/28/2021] [Indexed: 02/06/2023]
Abstract
Adenomyosis is a benign disease with a malignant behavior, bothering a lot of women at reproductive age who suffer from increased menstruation, prolonged menstruation, progressive dysmenorrhea, and infertility. At present, there is no effective treatment for adenomyosis. It seriously affects the life quality of these patients. However, the pathogenesis of adenomyosis is not yet clear. Recently, uterus junctional zone, defined as the inner 1/3 of myometrium between endometrium and myometrium, has gained broad attention. As is reported, the structure and function disorder of uterus junctional zone may play an important part in the occurrence and development of adenomyosis. In this issue, the present study generally reviews the role of uterine junction zone and the related mechanisms involved in adenomyosis, such as the local micro-damage, the formation of inflammatory and hypoxic microenvironment, changes of cytokines, and abnormalities of miRNA as well as signal pathways. It will provide new insights and potential therapeutic target strategies for clinical strategies in the management of adenomyosis.
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21
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Balasubramanian V, Saravanan R, Joseph LD, Dev B, Gouthaman S, Srinivasan B, Dharmarajan A, Rayala SK, Venkatraman G. Molecular dysregulations underlying the pathogenesis of endometriosis. Cell Signal 2021; 88:110139. [PMID: 34464692 DOI: 10.1016/j.cellsig.2021.110139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 01/07/2023]
Abstract
Endometriosis is a crippling disease characterized by the presence of endometrium-like tissue or scar outside the uterine cavity, commonly confined to the peritoneal and serosal surfaces of the pelvic organs. 10-15% of women in reproductive age are estimated to be affected by endometriosis. Most of these patients present with infertility and suffer from pelvic pain. The benign disease rarely progresses to malignancy. Regardless of its high prevalence, the pathogenesis of the disease is not fully understood. Treatment options for endometriosis are limited and are often based on a symptomatic approach. The unavailability of proper diagnostic approaches, fewer therapeutic options, and sparse understanding of molecular alterations are responsible for the continued disease burden. Exploring the molecular elements causing the pathogenesis of endometriosis may lead to a number of breakthroughs in the treatment of the illness, such as the discovery of new biomarkers for diagnosis and therapeutic targets that can be a guide to better prognosis and reduced recurrence. The goal of this review is to provide the reader a critical understanding of the disease by summarizing the genetic, immunological, hormonal, and epigenetic deregulations that support the molecular basis for development of endometriotic cyst, with a special focus on the study models needed to analyze these changes in the endometriotic microenvironment.
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Affiliation(s)
- Vaishnavi Balasubramanian
- Department of Human Genetics, Faculty of Biomedical Sciences, Technology and Research, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Roshni Saravanan
- Department of Human Genetics, Faculty of Biomedical Sciences, Technology and Research, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Leena Dennis Joseph
- Department of Pathology, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Bhawna Dev
- Department of Radiology, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Shanmugasundaram Gouthaman
- Department of Surgical Oncology, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Bhuvana Srinivasan
- Department of Obstetrics and Gynecology, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Arun Dharmarajan
- Department of Biomedical Sciences, Faculty of Biomedical Sciences, Technology and Research, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Suresh Kumar Rayala
- Department of Biotechnology, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India
| | - Ganesh Venkatraman
- Department of Human Genetics, Faculty of Biomedical Sciences, Technology and Research, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.
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22
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Chai X, Wu X, He L, Ding H. Protein arginine methyltransferase 5 mediates THP-1-derived macrophage activation dependent on NF-κB in endometriosis. Exp Ther Med 2021; 22:1003. [PMID: 34345285 PMCID: PMC8311241 DOI: 10.3892/etm.2021.10436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 05/24/2021] [Indexed: 01/16/2023] Open
Abstract
Macrophage-induced inflammation is a major factor in the pathogenesis of endometriosis. The underlying mechanisms, however, remain largely unknown. TNF-α, IL-6, IL-10 and C-C motif chemokine 20 (CCL20) levels in endometrial extracts were determined using Luminex cytokine kits. Additionally, protein arginine methyltransferase 5 (PRMT5) levels were measured using reverse transcription-quantitative PCR and western blotting. IL-6 and IP-10 levels in cells were measured using ELISA kits. In the present study, it was revealed that PRMT5 expression at both the mRNA and protein levels in THP-1-derived macrophages was significantly decreased following treatment with serum or extracts of endometrium from patients with endometriosis in the presence of lipopolysaccharide, compared with that in control cells, suggesting a possible role for macrophage-derived PRMT5 in mediating the interaction between macrophages and endometrium in endometriosis. Mechanistically, macrophage PRMT5 expression was regulated in an NF-κB-dependent and Smad2/3-independent manner, indicating that PRMT5 is a downstream target of NF-κB. Importantly, macrophage-derived PRMT5 was required for macrophage activation in endometriosis, as evidenced by the PRMT5-dependent secretion of IL-6 and IFN-γ-induced protein 10 from THP-1-derived macrophages. The present study identified NF-κB-dependent PRMT5 as a novel regulator of macrophage activation in endometriosis. Targeting PRMT5 in macrophages may be a potential therapeutic strategy against endometriosis.
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Affiliation(s)
- Xiaoshan Chai
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Xianqing Wu
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Ling He
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Hui Ding
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
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23
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Zhong Q, Yang F, Chen X, Li J, Zhong C, Chen S. Patterns of Immune Infiltration in Endometriosis and Their Relationship to r-AFS Stages. Front Genet 2021; 12:631715. [PMID: 34220927 PMCID: PMC8249861 DOI: 10.3389/fgene.2021.631715] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/24/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Endometriosis (EMS) is an estrogen-dependent disease in which endometrial glands and stroma arise outside the uterus. Current studies have suggested that the number and function of immune cells are abnormal in the abdominal fluid and ectopic lesion tissues of patients with EMS. The developed CIBERSORT method allows immune cell profiling by the deconvolution of gene expression microarray data. Methods: By applying CIBERSORT, we assessed the relative proportions of immune cells in 68 normal endometrial tissues (NO), 112 eutopic endometrial tissues (EU) and 24 ectopic endometrial tissues (EC). The obtained immune cell profiles provided enumeration and activation status of 22 immune cell subtypes. We obtained associations between the immune cell environment and EMS r-AFS stages. Macrophages were evaluated by immunohistochemistry (IHC) in 60 patients with ovarian endometriomas. Results: Total natural killer (NK) cells were significantly decreased in EC, while plasma cells and resting CD4 memory T cells were increased in EC. Total macrophages in EC were significantly increased compared to those of EU and NO, and M2 macrophages were the primary macrophages in EC. Compared to those of EC from patients with r-AFS stage I ~ II, M2 macrophages in EC from patients with stage III ~ IV were significantly increased. IHC experiments showed that total macrophages were increased in EC, with M2 macrophages being the primary subtype. Conclusions: Our data demonstrate that deconvolution of gene expression data by CIBERSORT provides valuable information about immune cell composition in EMS.
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Affiliation(s)
- Qiyu Zhong
- Department of Gynecology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Fan Yang
- Department of Gynecology and Obstetrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaochuan Chen
- Department of Gynecology and Obstetrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jinbo Li
- Department of Gynecology and Obstetrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Cailing Zhong
- Department of Gynecology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shuqin Chen
- Department of Gynecology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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24
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Gruber TM, Mechsner S. Pathogenesis of Endometriosis: The Origin of Pain and Subfertility. Cells 2021; 10:cells10061381. [PMID: 34205040 PMCID: PMC8226491 DOI: 10.3390/cells10061381] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/24/2021] [Accepted: 05/27/2021] [Indexed: 01/04/2023] Open
Abstract
Endometriosis (EM) and adenomyosis (AM) are common conditions with pain and infertility as the principal symptoms. The pathophysiology of pain in EM and AM comprises sensory and somatoform pain mechanisms. Over time, these may aggravate and lead to individual complex disease patterns if not diagnosed and treated. Despite the known facts, several years often pass between the onset of symptoms and diagnosis. Chronic pain disorders with changes on a neuronal level frequently arise and are linked to depressive disorders, with the process becoming a vicious cycle. Additionally, women with EM and AM suffer from sub- and infertility. Low fecundity rates are caused by anatomical changes in combination with behavioral changes in the sexual activity of women with chronic pain as well as local proinflammatory factors that not only decrease implantation rates but also promote early abortions.
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Affiliation(s)
- Teresa Mira Gruber
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Obstetrics, Augustenburger Platz 1, 13353 Berlin, Germany;
| | - Sylvia Mechsner
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Endometriosis Centre Charité, Department of Gynaecology, Augustenburger Platz 1, 13353 Berlin, Germany
- Correspondence:
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25
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Greenbaum H, Galper BEL, Decter DH, Eisenberg VH. Endometriosis and autoimmunity: Can autoantibodies be used as a non-invasive early diagnostic tool? Autoimmun Rev 2021; 20:102795. [DOI: 10.1016/j.autrev.2021.102795] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 01/08/2021] [Indexed: 12/21/2022]
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Ersoy B, Hey-Cunningham AJ, Lindsay L, Varol N, Markham R. Altered immune environment in peritoneal endometriotic lesions: relationship to lesion appearance. F&S SCIENCE 2021; 2:207-218. [PMID: 35559754 DOI: 10.1016/j.xfss.2020.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To study the localization of and quantify different immune cell populations in red, black, and white peritoneal endometriotic lesions and compare immune cell densities between lesions and the surrounding tissue. DESIGN Cross-sectional study. SETTING Teaching hospital, university research laboratory. PATIENT(S) Participants undergoing laparoscopic excision of endometriosis were recruited from gynecological operating theaters at Royal Prince Alfred Hospital, Sydney (n = 28). INTERVENTION(S) Immunohistochemical staining for and quantification of dendritic cells (mature and immature), T cells (effector, cytotoxic, and regulatory), B cells, and macrophages in endometriotic peritoneal lesions and the surrounding tissue. MAIN OUTCOME MEASURE(S) Immune cell densities and aggregates were quantified. RESULT(S) Red and black lesions are significantly more likely to be surrounded by immune cell aggregates than white lesions (P=.036). In the tissue surrounding the peritoneal endometriotic lesions, there was a consistent pattern of greater and more variable density of immune cell populations for red lesions than black or white lesions and a range of significant positive correlations between densities of different immune populations (all P≤.004; not observed within the lesion stroma). CONCLUSION(S) There is a greater presence of immune cells in the tissue surrounding earlier/red and black lesions than older scarred white lesions, particularly in the form of immune cell aggregates, indicating an immunologic response in close proximity to the adjacent lesion. The relationship between densities of immune populations in the tissue surrounding the lesions suggests complementary recruitment and local interactions between cells. Categorizing immune cell populations in proximity to peritoneal endometriotic lesions may improve the understanding of lesion persistence and transition to older white appearances. Early (red) peritoneal endometriotic lesions are surrounded by a greater density of immune cells, including immune aggregates, than later (black or white) lesions. These immune cells may support lesion persistence.
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Affiliation(s)
- Burcu Ersoy
- Obstetrics, Gynaecology and Neonatology, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Alison J Hey-Cunningham
- Obstetrics, Gynaecology and Neonatology, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Laura Lindsay
- Discipline of Anatomy and Histology, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Nesrin Varol
- Obstetrics, Gynaecology and Neonatology, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Obstetrics and Gynaecology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Robert Markham
- Obstetrics, Gynaecology and Neonatology, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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27
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Dückelmann AM, Taube E, Abesadze E, Chiantera V, Sehouli J, Mechsner S. When and how should peritoneal endometriosis be operated on in order to improve fertility rates and symptoms? The experience and outcomes of nearly 100 cases. Arch Gynecol Obstet 2021; 304:143-155. [PMID: 33537880 PMCID: PMC8164581 DOI: 10.1007/s00404-021-05971-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/12/2021] [Indexed: 12/18/2022]
Abstract
Purpose To analyze the follow-up results of patients suffering from symptomatic early-stage endometriosis after a consistent laparoscopic peritoneal stripping of the altered peritoneum (peritoneal endometriosis and surrounding inflamed tissue) was performed. This type of endometriosis is resistant to medical therapy and/or impairs fertility. Methods Using our prospectively maintained database, we were able to identify all symptomatic women with the suspicion of only peritoneal endometriosis who underwent laparoscopy at our endometriosis center over a period of 5 years. All procedures were carried out in a standardized fashion by one single surgeon, who is highly experienced in minimal invasive surgery, and included a suspended hormonal pretreatment for 2 months. Postoperative outcomes including complications, fertility and recurrence rates were analysed. Results Laparoscopic peritonectomy was performed on 94 women. Follow-up data were available in 87% of these cases. At the time of surgery, almost all patients tested showed signs of stage I or II endometriosis (44.7 and 48.9%, respectively). More than three-quarters of the women reported pain relief, inter alia, due to the post-surgical hormonal therapy. About one-third of the patients wanted to have children after the procedure. 62% of them became pregnant and the majority did so without the need for assisted reproductive therapy. In seven women a re-operation was performed. Conclusion According to our data, a consistent excision of altered peritoneum followed by adjuvant hormonal therapy and multimodal concepts results in better outcomes for the patient, particularly in regards to pregnancy and recurrence rates.
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Affiliation(s)
- A M Dückelmann
- Department of Gynecology, Charité-Universitätsmedizin BerlinVirchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - E Taube
- Department of Pathology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - E Abesadze
- Department of Gynecology, Vivantes Clinic Berlin Hellersdorf, Myslowitzerstr. 45, 12621, Berlin, Germany
| | - V Chiantera
- Department of Gynecologic Oncology, University of Palermo, Piazza Marina, 61, 90133, Palermo, Italy
| | - J Sehouli
- Department of Gynecology, Charité-Universitätsmedizin BerlinVirchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - S Mechsner
- Department of Gynecology, Charité-Universitätsmedizin BerlinVirchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
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Bourdon M, Santulli P, Jeljeli M, Vannuccini S, Marcellin L, Doridot L, Petraglia F, Batteux F, Chapron C. Immunological changes associated with adenomyosis: a systematic review. Hum Reprod Update 2020; 27:108-129. [PMID: 33099635 DOI: 10.1093/humupd/dmaa038] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 07/24/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Adenomyosis is a benign gynecological disorder associated with subfertility, pelvic pain and abnormal uterine bleeding that have significant consequences for the health and quality of life of women. Histologically, it is defined as the presence of ectopic endometrial islets within the myometrium. Its pathogenesis has not yet been elucidated and several pieces of the puzzle are still missing. One process involved in the development of adenomyosis is the increased capacity of some endometrial cells to infiltrate the myometrium. Moreover, the local and systemic immune systems are associated with the onset of the disease and with maintaining it. Numerous observations have highlighted the activation of immune cells and the release of immune soluble factors in adenomyosis. The contribution of immunity occurs in conjunction with hormonal aberrations and activation of the epithelial to mesenchymal transition (EMT) pathway, which promotes migration of endometrial cells. Here, we review current knowledge on the immunological changes in adenomyosis, with the aim of further elucidation of the pathogenesis of this disease. OBJECTIVE AND RATIONALE The objective was to systematically review the literature regarding the role of the immune system in development of adenomyosis in the inner and the outer myometrium, in humans. SEARCH METHODS A systematic review of published human studies was performed in MEDLINE, EMBASE and Cochrane Library databases from 1970 to February 2019 using the combination of Medical Subject Headings (MeSH): Adenomyosis AND ('Immune System' OR 'Gonadal Steroid Hormones'), and free-text terms for the following search terms (and their variants): Adenomyosis AND (immunity OR immune OR macrophage OR 'natural killer cell' OR lymphocyte* OR leucocyte* OR HLA OR inflammation OR 'sex steroid' OR 'epithelial to mesenchymal transition' OR 'EMT'). Studies in which no comparison was made with control patients, without adenomyosis (systemic sample and/or eutopic endometrium), were excluded. OUTCOMES A total of 42 articles were included in our systematic review. Changes in innate and adaptive immune cell numbers were described in the eutopic and/or ectopic endometrium of women with adenomyosis compared to disease-free counterparts. They mostly described an increase in lymphocyte and macrophage cell populations in adenomyosis eutopic endometrium compared to controls. These observations underscore the immune contributions to the disease pathogenesis. Thirty-one cytokines and other markers involved in immune pathways were studied in the included articles. Pro-inflammatory cytokines (interleukin (IL) 6, IL1β, interferon (IFN) α, tumor necrosis factor α, IFNγ) as well as anti-inflammatory or regulatory mediators (IL10, transforming growth factor β…) were found to be elevated in the eutopic endometrium and/or in the ectopic endometrium of the myometrium in women with adenomyosis compared to controls. Moreover, in women affected by adenomyosis, immunity was reported to be directly or indirectly linked to sex steroid hormone aberrations (notably changes in progesterone receptor in eutopic and ectopic endometrium) in three studies and to EMT in four studies. WIDER IMPLICATIONS The available literature clearly depicts immunological changes that are associated with adenomyosis. Both systemic and local immune changes have been described in women affected by adenomyosis, with the coexistence of changes in inflammatory as well as anti-inflammatory signals. It is likely that these immune changes, through an EMT mechanism, stimulate the migration of endometrial cells into the myometrium that, together with an endocrine imbalance, promote this inflammatory process. In light of the considerable impact of adenomyosis on women's health, a better understanding of the role played by the immune system in adenomyosis is likely to yield new research opportunities to better understand its pathogenesis.
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Affiliation(s)
- M Bourdon
- Université de Paris, Faculté de Médecine, Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, 27, rue du Faubourg-Saint-Jacques, 75015 Paris, France.,Department 3I "Infection, Immunité et inflammation", Institut Cochin, INSERM U1016, Paris, France.,Department of Gynaecology Obstetrics and Reproductive Medicine, Hopital Cochin, Paris, France
| | - P Santulli
- Université de Paris, Faculté de Médecine, Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, 27, rue du Faubourg-Saint-Jacques, 75015 Paris, France.,Department 3I "Infection, Immunité et inflammation", Institut Cochin, INSERM U1016, Paris, France.,Department of Gynaecology Obstetrics and Reproductive Medicine, Hopital Cochin, Paris, France
| | - M Jeljeli
- Université de Paris, Faculté de Médecine, Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, 27, rue du Faubourg-Saint-Jacques, 75015 Paris, France.,Department 3I "Infection, Immunité et inflammation", Institut Cochin, INSERM U1016, Paris, France.,Department of Immunology, Hopital Cochin, Paris, France
| | - S Vannuccini
- Division of Obstetrics and Gynecology, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Viale Morgagni 44, 50134 Florence, Italy.,Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - L Marcellin
- Université de Paris, Faculté de Médecine, Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, 27, rue du Faubourg-Saint-Jacques, 75015 Paris, France.,Department 3I "Infection, Immunité et inflammation", Institut Cochin, INSERM U1016, Paris, France.,Department of Gynaecology Obstetrics and Reproductive Medicine, Hopital Cochin, Paris, France
| | - L Doridot
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, 27, rue du Faubourg-Saint-Jacques, 75015 Paris, France.,Department 3I "Infection, Immunité et inflammation", Institut Cochin, INSERM U1016, Paris, France
| | - F Petraglia
- Division of Obstetrics and Gynecology, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Viale Morgagni 44, 50134 Florence, Italy
| | - F Batteux
- Université de Paris, Faculté de Médecine, Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, 27, rue du Faubourg-Saint-Jacques, 75015 Paris, France.,Department 3I "Infection, Immunité et inflammation", Institut Cochin, INSERM U1016, Paris, France.,Department of Immunology, Hopital Cochin, Paris, France
| | - C Chapron
- Université de Paris, Faculté de Médecine, Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, 27, rue du Faubourg-Saint-Jacques, 75015 Paris, France.,Department 3I "Infection, Immunité et inflammation", Institut Cochin, INSERM U1016, Paris, France.,Department of Gynaecology Obstetrics and Reproductive Medicine, Hopital Cochin, Paris, France
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Pashizeh F, Mansouri R, Davari-Tanha F, Hosseini R, Asgari Z, Aghaei H, Najafi Arbastan F, Rajaei S. Alterations of CD4+T Cell Subsets in Blood and Peritoneal Fluid in Different Stages of Endometriosis. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2020; 14:201-208. [PMID: 33098386 PMCID: PMC7604714 DOI: 10.22074/ijfs.2020.6127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 02/08/2020] [Indexed: 12/21/2022]
Abstract
Background Endometriosis is a chronic inflammatory disorder with known immune disturbances. The aim of this
study was to compare the frequency of different CD4+ T cells [T helper (Th)1, Th2, Th17 and regulatory T cells
(Tregs)] in peripheral blood (PB) and peritoneal fluid (PF) of patients that have early and advanced stages of endome-
triosis with a control group. Materials and Methods In this case control study, PB and PF samples were collected from women aged 24-40 years
who underwent laparoscopy procedures. The frequency of CD4+ T subsets were analysed by flow cytometry and com-
pared between three study groups; early endometriosis (stage I, II), advanced endometriosis (stage III, IV) and control
(no endometriosis). T cell numbers were compared between the PB and PF in each of the aforementioned groups. Results No statistically significant difference was found between the study groups regarding the numbers of Th1, Th2
and Th17 cells in PB. The PF of patients with advanced endometriosis had increased numbers of Th17 cells compared
to the control group (P=0.003), with P values of 0.059 and 0.045 in both menstrual phases. Increased numbers of Th2
cells in PF from early compared to advanced stages of endometriosis were detected exclusively in the luteal phase
(P=0.035).
The control group had increased numbers of Treg and Th2 cells in the PF compared to PB (both, P value=0.046).
However, in the early stages of endometriosis there were more Th2, Th17 and Treg cells in the PF compared to PB (P
values: 0.005, 0.047 and 0.013, respectively), while the number of Th17 cells was higher in the PF compared with PB
in the advanced stages of endometriosis (P= 0.013). Conclusion There were increased numbers of Th17 cells in the PF of patients with advanced stages of endometriosis,
which could be related to the severity of this disease.
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Affiliation(s)
- Fatemeh Pashizeh
- Department of Immunology, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Reza Mansouri
- Department of Immunology, School of Medicine, International Campus, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Fatemeh Davari-Tanha
- Department of Obstetrics and Gynaecology, Yas Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Reyhaneh Hosseini
- Department of Obstetrics and Gynaecology, Research Development Centre, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Asgari
- Department of Obstetrics and Gynaecology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamideh Aghaei
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Farangis Najafi Arbastan
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Samira Rajaei
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Electronic Address:
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30
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Weng LC, Hou SH, Lei ST, Peng HY, Li MQ, Zhao D. Estrogen-regulated CD200 inhibits macrophage phagocytosis in endometriosis. J Reprod Immunol 2020; 138:103090. [PMID: 32014721 DOI: 10.1016/j.jri.2020.103090] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/16/2020] [Accepted: 01/22/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Endometriosis (EMS) is a benign disease that is related to estrogen, immune disorders and inflammation. The purpose of this research was to determine the expression of CD200 in EMS and to clarify its role in the pathogenesis of the disease. METHODS The levels of serum CD200 in patients with and without EMS were determined by ELISA. Furthermore, the expression of CD200 in normal eutopic endometrium and ectopic endometrium was detected by immunohistochemistry and western blotting. The CD200 receptor (CD200R) in macrophages in peritoneal fluid (pMØ) obtained from controls and patients with EMS was examined by western blotting. CD200 expression in human endometrial stromal cells (HESCs) stimulated with 17β-estradiol (E2) was measured by western blotting. Furthermore, macrophages were stimulated with different concentrations of CD200 and the effect on phagocytosis was analyzed. RESULTS The plasma CD200 levels of patients with EMS was significantly increased compared with controls (P = 0.0173, 95%CI [18.75, 159.6]). Compared with normal eutopic endometrium, the expression of CD200 was significantly increased in ectopic endometrial tissues. The CD200R expression in pMØ obtained from patients with EMS was increased compared with the controls (P = 0.0244). CD200 expression in HESCs stimulated with E2 was up-regulated. As the levels of CD200 increased, macrophage phagocytosis in vitro gradually decreased. CONCLUSIONS CD200 is an estrogen-induced molecule that impairs macrophage phagocytosis and may contribute to the immune escape of ectopic lesions in EMS.
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Affiliation(s)
- Li-Chun Weng
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
| | - Shu-Hui Hou
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
| | - Sha-Ting Lei
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
| | - Hai-Yan Peng
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
| | - Ming-Qing Li
- Laboratory for Reproductive Immunology, NHC Key Lab of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Hospital of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, No.1326, Pingliang Road, Shanghai, 200080, People's Republic of China.
| | - Dong Zhao
- Department of Obstetrics and Gynecology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Rd., Shanghai, 200011, People's Republic of China.
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31
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Li MZ, Wu YH, Ali M, Wu XQ, Nie MF. Endometrial stromal cells treated by tumor necrosis factor-α stimulate macrophages polarized toward M2 via interleukin-6 and monocyte chemoattractant protein-1. J Obstet Gynaecol Res 2020; 46:293-301. [PMID: 31930665 DOI: 10.1111/jog.14135] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 09/22/2019] [Indexed: 12/17/2022]
Abstract
AIM This study aimed to investigate the effects of endometrial stromal cells (ESC)-derived interleukin (IL)-6 and monocyte chemoattractant protein (MCP)-1 on macrophage polarization in endometriosis. METHODS Macrophage polarization was measured in eutopic endometrium of control participants ('normal endometrium'), eutopic endometrium of patients with endometriosis ('eutopic endometrium') and ectopic endometrium of endometriosis patients ('ectopic endometrium') by immunohistochemical staining. Expression of IL-6 and MCP-1 were measured in the eutopic and ectopic endometrium through enzyme-linked immunosorbent assays. Expression of CD163 was measured in human acute monocytic leukemia (THP-1) cell-derived macrophages that were treated with conditional medium induced by tumor necrosis factor (TNF)-α, TNF-α + anti-IL-6 or TNF-α + anti-MCP-1 via flow cytometry. RESULTS The ratio of CD163+/CD68+ macrophages in the normal endometrium was higher than that in the eutopic endometrium, while differences between the eutopic and ectopic endometrium were not statistically significant. IL-6 and MCP-1 exhibited enhanced expression in the ectopic endometrium group and decreased expression in the eutopic endometrium group. TNF-α could promote the expression of ESC-derived IL-6 and MCP-1. Intervention with TNF-α-induced conditioned medium resulted in the upregulation of CD163 in THP-1 cells, while conditional medium induced with IL-6 and MCP-1 neutralizing antibodies decreased the proportion of CD163+ macrophages significantly. CONCLUSION In endometriosis patients, the macrophages of the eutopic endometrium polarize toward M1 compared with the normal endometrium, and those of the ectopic endometrium were mainly M2-polarized. Under the action of TNF-α, ESC-derived IL-6 and MCP-1 could stimulate peritoneal macrophages toward M2-polarization, which could modulate endometriosis.
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Affiliation(s)
- Min-Zhen Li
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ya-Hong Wu
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Maria Ali
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xian-Qing Wu
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Mei-Fang Nie
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital of Central South University, Changsha, China
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32
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Guo M, Bafligil C, Tapmeier T, Hubbard C, Manek S, Shang C, Martinez FO, Schmidt N, Obendorf M, Hess-Stumpp H, Zollner TM, Kennedy S, Becker CM, Zondervan KT, Cribbs AP, Oppermann U. Mass cytometry analysis reveals a distinct immune environment in peritoneal fluid in endometriosis: a characterisation study. BMC Med 2020; 18:3. [PMID: 31907005 PMCID: PMC6945609 DOI: 10.1186/s12916-019-1470-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/19/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Endometriosis is a gynaecological condition characterised by immune cell infiltration and distinct inflammatory signatures found in the peritoneal cavity. In this study, we aim to characterise the immune microenvironment in samples isolated from the peritoneal cavity in patients with endometriosis. METHODS We applied mass cytometry (CyTOF), a recently developed multiparameter single-cell technique, in order to characterise and quantify the immune cells found in peritoneal fluid and peripheral blood from endometriosis and control patients. RESULTS Our results demonstrate the presence of more than 40 different distinct immune cell types within the peritoneal cavity. This suggests that there is a complex and highly heterogeneous inflammatory microenvironment underpinning the pathology of endometriosis. Stratification by clinical disease stages reveals a dynamic spectrum of cell signatures suggesting that adaptations in the inflammatory system occur due to the severity of the disease. Notably, among the inflammatory microenvironment in peritoneal fluid (PF), the presence of CD69+ T cell subsets is increased in endometriosis when compared to control patient samples. On these CD69+ cells, the expression of markers associated with T cell function are reduced in PF samples compared to blood. Comparisons between CD69+ and CD69- populations reveal distinct phenotypes across peritoneal T cell lineages. Taken together, our results suggest that both the innate and the adaptive immune system play roles in endometriosis. CONCLUSIONS This study provides a systematic characterisation of the specific immune environment in the peritoneal cavity and identifies cell immune signatures associated with endometriosis. Overall, our results provide novel insights into the specific cell phenotypes governing inflammation in patients with endometriosis. This prospective study offers a useful resource for understanding disease pathology and opportunities for identifying therapeutic targets.
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Affiliation(s)
- Manman Guo
- Botnar Research Centre, NIHR Biomedical Research Unit Oxford, Nuffield Department of Musculoskeletal Sciences, University of Oxford, Oxford, UK.
| | - Cemsel Bafligil
- Botnar Research Centre, NIHR Biomedical Research Unit Oxford, Nuffield Department of Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Thomas Tapmeier
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Carol Hubbard
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Sanjiv Manek
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Catherine Shang
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Fernando O Martinez
- Botnar Research Centre, NIHR Biomedical Research Unit Oxford, Nuffield Department of Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Nicole Schmidt
- Bayer AG, Drug Discovery Pharmaceuticals, Gynecological Therapies, Müllerstr. 178, Berlin, Germany
| | - Maik Obendorf
- Bayer AG, Drug Discovery Pharmaceuticals, Gynecological Therapies, Müllerstr. 178, Berlin, Germany
| | - Holger Hess-Stumpp
- Bayer AG, Drug Discovery Pharmaceuticals, Gynecological Therapies, Müllerstr. 178, Berlin, Germany
| | - Thomas M Zollner
- Bayer AG, Drug Discovery Pharmaceuticals, Gynecological Therapies, Müllerstr. 178, Berlin, Germany
| | - Stephen Kennedy
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Christian M Becker
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Krina T Zondervan
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
- The Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Adam P Cribbs
- Botnar Research Centre, NIHR Biomedical Research Unit Oxford, Nuffield Department of Musculoskeletal Sciences, University of Oxford, Oxford, UK.
| | - Udo Oppermann
- Botnar Research Centre, NIHR Biomedical Research Unit Oxford, Nuffield Department of Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Freiburg Institute for Advanced Studies (FRIAS), University of Freiburg, Freiburg im Breisgau, Germany
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Vallvé-Juanico J, Houshdaran S, Giudice LC. The endometrial immune environment of women with endometriosis. Hum Reprod Update 2019; 25:564-591. [PMID: 31424502 PMCID: PMC6737540 DOI: 10.1093/humupd/dmz018] [Citation(s) in RCA: 220] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 03/07/2019] [Accepted: 04/18/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Endometriosis, a common oestrogen-dependent inflammatory disorder in women of reproductive age, is characterized by endometrial-like tissue outside its normal location in the uterus, which causes pelvic scarring, pain and infertility. While its pathogenesis is poorly understood, the immune system (systemically and locally in endometrium, pelvic endometriotic lesions and peritoneal fluid) is believed to play a central role in its aetiology, pathophysiology and associated morbidities of pain, infertility and poor pregnancy outcomes. However, immune cell populations within the endometrium of women with the disease have had incomplete phenotyping, thereby limiting insight into their roles in this disorder. OBJECTIVE AND RATIONALE The objective herein was to determine reproducible and consistent findings regarding specific immune cell populations and their abundance, steroid hormone responsiveness, functionality, activation states, and markers, locally and systemically in women with and without endometriosis. SEARCH METHODS A comprehensive English language PubMed, Medline and Google Scholar search was conducted with key search terms that included endometriosis, inflammation, human eutopic/ectopic endometrium, immune cells, immune population, immune system, macrophages, dendritic cells (DC), natural killer cells, mast cells, eosinophils, neutrophils, B cells and T cells. OUTCOMES In women with endometriosis compared to those without endometriosis, some endometrial immune cells display similar cycle-phase variation, whereas macrophages (Mø), immature DC and regulatory T cells behave differently. A pro-inflammatory Mø1 phenotype versus anti-inflammatory Mø2 phenotype predominates and natural killer cells display abnormal activity in endometrium of women with the disease. Conflicting data largely derive from small studies, variably defined hormonal milieu and different experimental approaches and technologies. WIDER IMPLICATIONS Phenotyping immune cell subtypes is essential to determine the role of the endometrial immune niche in pregnancy and endometrial homeostasis normally and in women with poor reproductive history and can facilitate development of innovative diagnostics and therapeutics for associated symptoms and compromised reproductive outcomes.
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Affiliation(s)
- Júlia Vallvé-Juanico
- Department of Gynecology, IVI Barcelona S.L., 08017, Barcelona, Spain
- Group of Biomedical Research in Gynecology, Vall Hebron Research Institute (VHIR) and University Hospital, 08035, Barcelona, Spain
- Universitat Autònoma de Barcelona, 08193, Bellaterra (Barcelona), Spain
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA 94193, USA
| | - Sahar Houshdaran
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA 94193, USA
| | - Linda C Giudice
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA 94193, USA
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Abesadze E, Sehouli J, Mechsner S, Chiantera V. Possible Role of the Posterior Compartment Peritonectomy, as a Part of the Complex Surgery, Regarding Recurrence Rate, Improvement of Symptoms and Fertility Rate in Patients with Endometriosis, Long-Term Follow-Up. J Minim Invasive Gynecol 2019; 27:1103-1111. [PMID: 31449906 DOI: 10.1016/j.jmig.2019.08.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 08/12/2019] [Accepted: 08/16/2019] [Indexed: 12/18/2022]
Abstract
STUDY OBJECTIVE Beside the pain, there are 2 further problems in the management of endometriosis: the high recurrence rate (10% per year) and the high rate of impaired fertility. The objective of this study was to investigate the pathogenesis of these 2 factors. DESIGN This is a retrospective cohort study, and the aim is to evaluate the complete excision of endometriotic lesions, including the posterior compartment of the peritoneum, with regard to postoperative outcome, focusing on relieving pain, increasing fertility rate, and decreasing recurrence rate. SETTING Charité-University Clinic, Department of Gynaecology, Endometriosis research Centre. PATIENTS Fifty-four patients were enrolled in this study, with severe deep infiltrating endometriosis (scored by ENZIAN) and superficial endometriosis, as well as endometriomas (revised American Society for Reproductive Medicine [rASRM] I = 3; II = 15; III = 10; and IV = 26). INTERVENTIONS Posterior compartment peritonectomy (visible endometriotic lesions and inflamed altered peritoneum) was performed in all patients as part of a complex surgery: complete excision of endometriosis. MEASUREMENTS AND MAIN RESULTS Postoperative outcomes were evaluated, based on the postoperative follow-up (up to 5 years) of 54 investigated patients. In 36 women (66%) preoperative complaints were eliminated. Furthermore, of 28 women seeking improved fertility, pregnancy was reported in 13 cases (46%). In 7 (54%) cases pregnancy occurred spontaneously, and in the remainder with assisted fertilization. In addition, long-term follow-up demonstrated a recurrence rate in 1.8% of patients. CONCLUSION Overall, the number of complaints was significantly reduced. Only in the case of reproductive-aged women with ongoing postoperative complaints was it important to preserve the uterus. Although this pilot study on systematic posterior peritonectomy showed improvement in recurrence and fertility rate, the main question remains: will this surgical technique achieve better results and outcomes in the future? This has to be addressed in a prospective randomized study.
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Affiliation(s)
- Elene Abesadze
- Endometriosis Centre Charité, Department of Gynaecology, Charité, Campus Virchow Clinic, Berlin, Germany (Drs. Abesadze, Sehouli, Mechsner, and Chiantera)
| | - Jalid Sehouli
- Endometriosis Centre Charité, Department of Gynaecology, Charité, Campus Virchow Clinic, Berlin, Germany (Drs. Abesadze, Sehouli, Mechsner, and Chiantera)
| | - Sylvia Mechsner
- Endometriosis Centre Charité, Department of Gynaecology, Charité, Campus Virchow Clinic, Berlin, Germany (Drs. Abesadze, Sehouli, Mechsner, and Chiantera).
| | - Vito Chiantera
- Endometriosis Centre Charité, Department of Gynaecology, Charité, Campus Virchow Clinic, Berlin, Germany (Drs. Abesadze, Sehouli, Mechsner, and Chiantera); University of Palermo, Palermo, Italy (Dr. Chiantera)
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35
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Mattos RMD, Machado DE, Perini JA, Alessandra-Perini J, Meireles da Costa NDO, Wiecikowski AFDRDO, Cabral KMDS, Takiya CM, Carvalho RS, Nasciutti LE. Galectin-3 plays an important role in endometriosis development and is a target to endometriosis treatment. Mol Cell Endocrinol 2019; 486:1-10. [PMID: 30753853 DOI: 10.1016/j.mce.2019.02.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 02/08/2019] [Accepted: 02/08/2019] [Indexed: 12/14/2022]
Abstract
This study aimed to analyze galectin-3 importance in endometriotic lesions development and the effect of recombinant Gal-3 carbohydrate recognition domain (Gal3C) in experimental endometriosis treatment. Experimental endometriosis was induced in WT and Gal-3-/- mice. Initially developed lesions were macroscopically and histologically analyzed, including immunohistochemical analysis. Then, WT mice were treated with Gal3C for 15 days. Gal-3 deficiency and Gal3C treatment significantly impaired endometriosis development. A significant decrease in lesions implantation and size, VEGF and VEGFR-2 expression, vascular density and macrophage distribution were observed in Gal-3 absence or inhibition. A greater presence of iNOS positive cells was observed in knockout mice lesions, while the presence of Arginase positive cells was higher in the WT animal lesions. In addition, COX-2 and TGFb1 were reduced by Gal3C treatment. Data showed here indicate a relevant role of Gal-3 in endometriosis development and highlight a target of endometriosis treatment using Gal-3 inhibitor.
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Affiliation(s)
- Rômulo Medina de Mattos
- Morphological Sciences Program, Biomedical Sciences Institute, Federal University of Rio de Janeiro - UFRJ, Rio de Janeiro, RJ, Brazil; University Center IBMR, Laureate Universities, Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | - Daniel Escorsim Machado
- Morphological Sciences Program, Biomedical Sciences Institute, Federal University of Rio de Janeiro - UFRJ, Rio de Janeiro, RJ, Brazil; Research Laboratory of Pharmaceutical Sciences, West Zone State University - UEZO, Rio de Janeiro, RJ, Brazil
| | - Jamila Alessandra Perini
- Research Laboratory of Pharmaceutical Sciences, West Zone State University - UEZO, Rio de Janeiro, RJ, Brazil; Program of Post-graduation in Public Health and Environment, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Jéssica Alessandra-Perini
- Morphological Sciences Program, Biomedical Sciences Institute, Federal University of Rio de Janeiro - UFRJ, Rio de Janeiro, RJ, Brazil; Research Laboratory of Pharmaceutical Sciences, West Zone State University - UEZO, Rio de Janeiro, RJ, Brazil
| | | | | | - Katia Maria Dos Santos Cabral
- National Center of Structural Biology and Bioimaging (CENABIO), Federal University of Rio de Janeiro - UFRJ, Rio de Janeiro, RJ, Brazil
| | - Christina Maeda Takiya
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Renato Sampaio Carvalho
- Laboratory of Molecular Targets, Pharmaceutical Biotechnology Department, Faculty of Pharmacy, Federal University of Rio de Janeiro - UFRJ, Rio de Janeiro, RJ, Brazil
| | - Luiz Eurico Nasciutti
- Morphological Sciences Program, Biomedical Sciences Institute, Federal University of Rio de Janeiro - UFRJ, Rio de Janeiro, RJ, Brazil.
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36
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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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37
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Wu L, Lv C, Su Y, Li C, Zhang H, Zhao X, Li M. Expression of programmed death-1 (PD-1) and its ligand PD-L1 is upregulated in endometriosis and promoted by 17beta-estradiol. Gynecol Endocrinol 2019; 35:251-256. [PMID: 30325236 DOI: 10.1080/09513590.2018.1519787] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The programmed death-1 (PD-1)/PD-L1 pathway plays important roles in immune responses and peripheral tolerance. Under pathological conditions, this pathway can suppress protective T cell responses and induce immune system disorders. Endometriosis (EM) is an estrogen-dependent, immune-associated disease. The expression of PD-1 and PD-L1 has been studied in a variety of cancers and autoimmune diseases. Few studies, however, have attempted to explore their expression and the possibility that they are regulated by estrogen in EM. Eutopic and ectopic endometria and blood samples were collected from 15 women with EM and 15 women without EM. PD-1/PD-L1 expression in endometrial tissues was detected using immunohistochemistry and western blot analysis. Their expression in blood was detected using flow cytometry. In addition, their expression was evaluated in endometrial cells after estrogen and cytokine treatment. We observed PD-1/PD-L1 expression in both eutopic and ectopic endometria, with elevated expression in EM. Their expression was also higher in CD4+/CD8+ T cells in blood from EM patients. In addition, treatment with 17β-estradiol upregulated PD-L1 expression in eutopic epithelial cells in EM. These data suggest that the PD-1/PD-L1 pathway may be involved in EM immune dysfunction and be regulated by estrogen.
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Affiliation(s)
- Lukanxuan Wu
- a Dapartmen of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated for Shandong University, Jinan , Shandong , People's Republic of China
| | - Chunzi Lv
- a Dapartmen of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated for Shandong University, Jinan , Shandong , People's Republic of China
| | - Yifeng Su
- a Dapartmen of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated for Shandong University, Jinan , Shandong , People's Republic of China
| | - Chunyan Li
- a Dapartmen of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated for Shandong University, Jinan , Shandong , People's Republic of China
| | - Hui Zhang
- a Dapartmen of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated for Shandong University, Jinan , Shandong , People's Republic of China
| | - Xinbo Zhao
- a Dapartmen of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated for Shandong University, Jinan , Shandong , People's Republic of China
| | - Mingjiang Li
- a Dapartmen of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated for Shandong University, Jinan , Shandong , People's Republic of China
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Liang Y, Xie H, Wu J, Liu D, Yao S. Villainous role of estrogen in macrophage-nerve interaction in endometriosis. Reprod Biol Endocrinol 2018; 16:122. [PMID: 30518376 PMCID: PMC6282253 DOI: 10.1186/s12958-018-0441-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 11/23/2018] [Indexed: 02/07/2023] Open
Abstract
Endometriosis is a complex and heterogeneous disorder with unknown etiology. Dysregulation of macrophages and innervation are important factors influencing the pathogenesis of endometriosis-associated pain. It is known to be an estrogen-dependent disease, estrogen can promote secretion of chemokines from peripheral nerves, enhancing the recruitment and polarization of macrophages in endometriotic tissue. Macrophages have a role in the expression of multiple nerve growth factors (NGF), which mediates the imbalance of neurogenesis in an estrogen-dependent manner. Under the influence of estrogen, co-existence of macrophages and nerves induces an innovative neuro-immune communication. Persistent stimulation by inflammatory cytokines from macrophages on nociceptors of peripheral nerves aggravates neuroinflammation through the release of inflammatory neurotransmitters. This neuro-immune interaction regulated by estrogen sensitizes peripheral nerves, leading to neuropathic pain in endometriosis. The aim of this review is to highlight the significance of estrogen in the interaction between macrophages and nerve fibers, and to suggest a potentially valuable therapeutic target for endometriosis-associated pain.
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Affiliation(s)
- Yanchun Liang
- grid.412615.5Department of Obstetrics and Gynecology, First Affiliated Hospital, Sun Yat-sen University, No. 58, the 2nd Zhongshan Road, Yuexiu District, Guangzhou, Guangdong Province China
| | - Hongyu Xie
- 0000 0001 2360 039Xgrid.12981.33Grade 2012 in 8-year Medical Education Program of Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510089 China
| | - Jinjie Wu
- 0000 0001 2360 039Xgrid.12981.33Grade 2012 in 8-year Medical Education Program of Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510089 China
| | - Duo Liu
- grid.412615.5Department of Obstetrics and Gynecology, First Affiliated Hospital, Sun Yat-sen University, No. 58, the 2nd Zhongshan Road, Yuexiu District, Guangzhou, Guangdong Province China
| | - Shuzhong Yao
- grid.412615.5Department of Obstetrics and Gynecology, First Affiliated Hospital, Sun Yat-sen University, No. 58, the 2nd Zhongshan Road, Yuexiu District, Guangzhou, Guangdong Province China
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Machado DE, Perini JA, de Mendonça EM, Branco JR, Rodrigues-Baptista KC, Alessandra-Perini J, Espíndola-Netto JM, Dos Santos TA, Coelho WS, Nasciutti LE, Sola-Penna M, Zancan P. Clotrimazole is effective for the regression of endometriotic implants in a Wistar rat experimental model of endometriosis. Mol Cell Endocrinol 2018; 476:17-26. [PMID: 29689297 DOI: 10.1016/j.mce.2018.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/09/2018] [Accepted: 04/09/2018] [Indexed: 01/31/2023]
Abstract
The present work aimed to evaluate molecular, angiogenic and inflammatory changes induced by clotrimazole (CTZ) on endometriosis lesions. For this, thirty female Wistar rats with surgically implanted autologous endometrium were treated with CTZ or vehicle (200 mg/kg) via esophageal gavage for 15 consecutive days. CTZ treatment significantly decreased the growth and the size of the implants, and histological examination indicated regression and atrophy, with no toxicity to the animals. The levels of the angiogenic markers VEGF and VEGFR-2 were significantly decreased in CTZ group. The treatment also promotes a reduction on PGE2 and TNF-α levels. All these effects involve the amelioration of ERK1/2, Akt, AMPK and PERK signaling upon CTZ treatment. In conclusion, CTZ promoted an overall amelioration of endometriosis in a rat model due to the anti-angiogenic properties of the drug. Therefore, our results support the proposal of a clinical trial using CTZ for the treatment of endometriosis.
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Affiliation(s)
- Daniel Escorsim Machado
- Unidade de Farmácia, Centro Universitário Estadual da Zona Oeste, Rio de Janeiro, RJ, Brazil; Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Jamila Alessandra Perini
- Unidade de Farmácia, Centro Universitário Estadual da Zona Oeste, Rio de Janeiro, RJ, Brazil; Programa de Pós-Graduação em Saúde Pública e Meio Ambiente, Escola Nacional de Saúde Pública, Fundação Osvaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Erika Menezes de Mendonça
- Unidade de Farmácia, Centro Universitário Estadual da Zona Oeste, Rio de Janeiro, RJ, Brazil; Programa de Pós-Graduação em Saúde Pública e Meio Ambiente, Escola Nacional de Saúde Pública, Fundação Osvaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Jessica Ristow Branco
- Laboratório de Oncobiologia Molecular (LabOMol), Departamento de Biotecnologia Farmacêutica (BioTecFar), Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Karina Cristina Rodrigues-Baptista
- Unidade de Farmácia, Centro Universitário Estadual da Zona Oeste, Rio de Janeiro, RJ, Brazil; Programa de Pós-Graduação em Saúde Pública e Meio Ambiente, Escola Nacional de Saúde Pública, Fundação Osvaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Jessica Alessandra-Perini
- Unidade de Farmácia, Centro Universitário Estadual da Zona Oeste, Rio de Janeiro, RJ, Brazil; Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Jair Machado Espíndola-Netto
- Laboratório de Enzimologia e Controle do Metabolismo (LabECoM), Departamento de Biotecnologia Farmacêutica (BioTecFar), Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Thiago Alves Dos Santos
- Unidade de Farmácia, Centro Universitário Estadual da Zona Oeste, Rio de Janeiro, RJ, Brazil
| | - Wagner Santos Coelho
- Unidade de Farmácia, Centro Universitário Estadual da Zona Oeste, Rio de Janeiro, RJ, Brazil
| | - Luiz Eurico Nasciutti
- Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Mauro Sola-Penna
- Laboratório de Enzimologia e Controle do Metabolismo (LabECoM), Departamento de Biotecnologia Farmacêutica (BioTecFar), Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Patricia Zancan
- Laboratório de Oncobiologia Molecular (LabOMol), Departamento de Biotecnologia Farmacêutica (BioTecFar), Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
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Gajbhiye R, McKinnon B, Mortlock S, Mueller M, Montgomery G. Genetic Variation at Chromosome 2q13 and Its Potential Influence on Endometriosis Susceptibility Through Effects on the IL-1 Family. Reprod Sci 2018; 25:1307-1317. [PMID: 29669463 DOI: 10.1177/1933719118768688] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Endometriosis is characterized by the growth of epithelial and stromal cells outside the uterine cavity. It has a complex etiology and affects ∼10% of reproductive age women. It is accompanied by a chronic inflammatory response with substantial evidence to indicate genetic susceptibility. The causal genes and their pathways leading to endometriosis, however, are still unknown. Recently, genomewide association studies on endometriosis identified 14 genomic risk loci in women of European and Japanese ancestry. It is becoming increasingly clear that these risk regions are intergenic and thus contribute to disease susceptibility through regulatory mechanisms, most likely mediated through regulation of genes within a restricted distance from the risk variants. One endometriosis risk locus has been detected at chromosome 2q13 within an inflammatory-rich region of gene transcripts and thus may play a role in the inflammation component of the disease. We carried out detailed analysis of the genomic region 250 kb on either side of sentinel SNP rs10167914 and identified 21 transcripts which contained 6 interleukin (IL)-1 family genes, 3 previously reported coding genes that have a relationship to inflammation, 4 novel coding, or pseudogenes, and 8 noncoding RNA transcripts. Through an extensive literature search, we examined the roles these genes and their resultant proteins play in endometriosis pathogenesis. The results suggest alteration in the expression the IL-1 family transcripts either alone or as a complex milieu could have a significant influence on endometriosis and should be prioritized for future study on the implications of inflammation on endometriotic lesions.
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Affiliation(s)
- Rahul Gajbhiye
- 1 Institute for Molecular Bioscience, University of Queensland, St. Lucia, QLD, Australia.,3 Department of Clinical Research, ICMR-National Institute for Research in Reproductive Health, Parel, Mumbai, Maharashtra, India
| | - Brett McKinnon
- 2 Department of Obstetrics and Gynaecology, Inselspital, Berne University Hospital, Bern, Switzerland
| | - Sally Mortlock
- 1 Institute for Molecular Bioscience, University of Queensland, St. Lucia, QLD, Australia
| | - Michael Mueller
- 2 Department of Obstetrics and Gynaecology, Inselspital, Berne University Hospital, Bern, Switzerland
| | - Grant Montgomery
- 1 Institute for Molecular Bioscience, University of Queensland, St. Lucia, QLD, Australia
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Xu Y, Zhao W, Li T, Zhao Y, Bu H, Song S. Effects of acupuncture for the treatment of endometriosis-related pain: A systematic review and meta-analysis. PLoS One 2017; 12:e0186616. [PMID: 29077705 PMCID: PMC5659600 DOI: 10.1371/journal.pone.0186616] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 10/04/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Endometriosis is a multifactorial, oestrogen-dependent, inflammatory, gynaecological condition that can result in long-lasting visceral pelvic pain and infertility. Acupuncture could be an effective treatment for endometriosis and may relieve pain. Our aim in the present study was to determine the effectiveness of acupuncture as a treatment for endometriosis-related pain. METHODS In December 2016, six databases were searched for randomised controlled trials that determined the effectiveness of acupuncture in the treatment of endometriosis-related pain. Ultimately, 10 studies involving 589 patients were included. The main outcomes assessed were variation in pain level, variation in peripheral blood CA-125 level, and clinical effective rate. All analyses were performed using comprehensive meta-analysis statistical software. RESULTS Of the 10 studies included, only one pilot study used a placebo control and assessed blinding; the rest used various controls (medications and herbs), which were impossible to blind. The sample sizes were small in all studies, ranging from 8 to 36 patients per arm. The mean difference (MD) in pain reduction (pre- minus post-interventional pain level-measured on a 0-10-point scale) between the acupuncture and control groups was 1.36 (95% confidence intervals [CI] = 1.01-1.72, P<0.0001). Acupuncture had a positive effect on peripheral blood CA-125 levels, as compared with the control groups (MD = 5.9, 95% CI = 1.56-10.25, P = 0.008). Similarly, the effect of acupuncture on clinical effective rate was positive, as compared with the control groups (odds ratio = 2.07; 95% CI = 1.24-3.44, P = 0.005). CONCLUSIONS Few randomised, blinded clinical trials have addressed the efficacy of acupuncture in treating endometriosis-related pain. Nonetheless, the current literature suggests that acupuncture reduces pain and serum CA-125 levels, regardless of the control intervention used. To confirm these findings, additional, blinded studies with proper controls and adequate sample sizes are needed.
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Affiliation(s)
- Yang Xu
- Department of Gynecology and Obstetrics, Nankai Hospital, Tianjin Academy of Integrative Medicine, Tianjin, China
| | - Wenli Zhao
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Department of Neurology, Nankai Hospital, Tianjin Academy of Integrative Medicine, Tianjin, China
| | - Te Li
- Department of Chinese Medicine, Tianjin Hearing Impairment Specialist Hospital, Tianjin, China
| | - Ye Zhao
- Department of Chemical Engineering, University of Florida, Gainesville, Florida, United States of America
| | - Huaien Bu
- Department of Public Health, School of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
- * E-mail: (HB); (SS)
| | - Shilin Song
- Laboratory of Anatomy, School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
- * E-mail: (HB); (SS)
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42
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Yang HL, Zhou WJ, Chang KK, Mei J, Huang LQ, Wang MY, Meng Y, Ha SY, Li DJ, Li MQ. The crosstalk between endometrial stromal cells and macrophages impairs cytotoxicity of NK cells in endometriosis by secreting IL-10 and TGF-β. Reproduction 2017; 154:815-825. [PMID: 28971893 DOI: 10.1530/rep-17-0342] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/31/2017] [Accepted: 09/29/2017] [Indexed: 02/04/2023]
Abstract
The dysfunction of NK cells in women with endometriosis (EMS) contributes to the immune escape of menstrual endometrial fragments refluxed into the peritoneal cavity. The reciprocal communications between endometrial stromal cells (ESCs) and lymphocytes facilitate the development of EMS. However, the mechanism of these communications on cytotoxicity of natural killer (NK) cells in endometriotic milieus is still largely unknown. To imitate the local immune microenvironment, the co-culture systems of ESCs from patients with EMS and monocyte-derived macrophages or of ESCs, macrophages and NK cells were constructed. The cytokine levels in the co-culture unit were evaluated by ELISA. The expression of functional molecules in NK cells was detected by flow cytometry (FCM). The NK cell behaviors in vitro were analyzed by cell counting kit-8 and cytotoxic activation assays. After incubation with ESCs and macrophages, the expression of CD16, NKG2D, perforin and IFN-γ, viability and cytotoxicity of NK cells were significantly downregulated. The secretion of interleukin (IL)-1β, IL-10 and transforming growth factor (TGF)-β in the co-culture system of ESCs and macrophages was increased. Exposure with anti-IL-10 receptor β neutralizing antibody (αhIL-10Rβ) or αTGF-β could partly reverse these effects of ESCs and macrophages on NK cells in vitro These results suggest that the interaction between macrophages and ESCs downregulates cytotoxicity of NK cells possibly by stimulating the secretion of IL-10 and TGF-β, and may further trigger the immune escape of ectopic fragments and promote the occurrence and the development of EMS.
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Affiliation(s)
- Hui-Li Yang
- Laboratory for Reproductive ImmunologyHospital of Obstetrics and Gynecology, Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Reproduction Regulation of NPFPCSIPPR, IRD, Fudan University, Shanghai, People's Republic of China
| | - Wen-Jie Zhou
- Laboratory for Reproductive ImmunologyHospital of Obstetrics and Gynecology, Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Reproduction Regulation of NPFPCSIPPR, IRD, Fudan University, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related DiseasesShanghai, People's Republic of China
| | - Kai-Kai Chang
- Laboratory for Reproductive ImmunologyHospital of Obstetrics and Gynecology, Fudan University, Shanghai, People's Republic of China
| | - Jie Mei
- Reproductive Medicine CenterDepartment of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medicine School, Nanjing, People's Republic of China
| | - Li-Qing Huang
- Department of Statistics and PsychologyCollege of Letters and Science, University of California Davis, Davis, California, USA
| | - Ming-Yan Wang
- Laboratory for Reproductive ImmunologyHospital of Obstetrics and Gynecology, Fudan University, Shanghai, People's Republic of China
| | - Yi Meng
- Laboratory for Reproductive ImmunologyHospital of Obstetrics and Gynecology, Fudan University, Shanghai, People's Republic of China
| | - Si-Yao Ha
- Laboratory for Reproductive ImmunologyHospital of Obstetrics and Gynecology, Fudan University, Shanghai, People's Republic of China
| | - Da-Jin Li
- Laboratory for Reproductive ImmunologyHospital of Obstetrics and Gynecology, Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Reproduction Regulation of NPFPCSIPPR, IRD, Fudan University, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related DiseasesShanghai, People's Republic of China
| | - Ming-Qing Li
- Laboratory for Reproductive ImmunologyHospital of Obstetrics and Gynecology, Fudan University, Shanghai, People's Republic of China .,Key Laboratory of Reproduction Regulation of NPFPCSIPPR, IRD, Fudan University, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related DiseasesShanghai, People's Republic of China
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Riccio LGC, Baracat EC, Chapron C, Batteux F, Abrão MS. The role of the B lymphocytes in endometriosis: A systematic review. J Reprod Immunol 2017; 123:29-34. [PMID: 28910679 DOI: 10.1016/j.jri.2017.09.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 08/01/2017] [Accepted: 09/06/2017] [Indexed: 01/06/2023]
Abstract
The physiopathology of endometriosis is not completely understood and its progression is associated with a local and systemic inflammatory reaction. It is important to clarify the potential role of the immune system to better understand its implication in the pathogenesis of endometriosis, which includes the study of the role of B cells and antibodies. The aim of this study was to review the literature about the role of B lymphocytes in endometriosis. A search for "endometriosis", "B cells" and "B lymphocytes" in databases resulted in 140 citations; after applying inclusion and exclusion criteria, a total of 22 studies were assessed. The analyzed samples in the studies varied and different markers and techniques were used by the authors to evaluate the direct or indirect role of B lymphocytes in endometriosis. Most studies demonstrated increased number and/or activation of B cells while seven studies found no difference and two studies showed decreased number of B cells. Increased B lymphocytes and excessive production of autoantibodies in endometriosis have been described in the literature, but their role in the development of the disease is not well understood. Moreover, the association of these factors with clinical symptoms, location and severity of the disease has not been investigated. Further studies are necessary to clarify the role of B cells in the development of endometriosis and propose new therapeutic strategies such as the use of drugs that target these cells.
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Affiliation(s)
- L G C Riccio
- School of Medicine, University of São Paulo, Endometriosis Division, Obstetrics and Gynecology Department, São Paulo, Brazil; Department of Development, Reproduction and Cancer, Institut Cochin, INSERM U1016-Batteux, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
| | - E C Baracat
- School of Medicine, University of São Paulo, Endometriosis Division, Obstetrics and Gynecology Department, São Paulo, Brazil.
| | - C Chapron
- Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique - Hôpitaux de Paris (AP-HP), Groupe Hospitalier Universitaire (GHU) Ouest, Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynecology Obstetrics II and Reproductive Medicine, Université Paris Descartes, Paris, France; Department of Development, Reproduction and Cancer, Institut Cochin, INSERM U1016-Batteux, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
| | - F Batteux
- Department of Development, Reproduction and Cancer, Institut Cochin, INSERM U1016-Batteux, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Department of Immunology, Hôpital Cochin, AP-HP, Paris, France.
| | - M S Abrão
- School of Medicine, University of São Paulo, Endometriosis Division, Obstetrics and Gynecology Department, São Paulo, Brazil.
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Jiang C, Liu C, Guo J, Chen L, Luo N, Qu X, Yang W, Ren Q, Cheng Z. The Expression of Toll-like receptors in eutopic and ectopic endometrium and its implication in the inflammatory pathogenesis of adenomyosis. Sci Rep 2017; 7:7365. [PMID: 28779087 PMCID: PMC5544718 DOI: 10.1038/s41598-017-07859-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 07/03/2017] [Indexed: 11/08/2022] Open
Abstract
In this study, we investigated the expression profiles of Toll-like receptors(TLRs) in eutopic endometrium(EU) and ectopic endometrium(EC) and its implication in the inflammatory pathogenesis of adenomyosis. Thirty adenomyosis patients who underwent laparoscopy were recruited in this study. We tested the mRNA and protein expression of TLRs, and the mRNA expression of IL-6 and IL-8 in EU and EC of adenomyosis patients, and control endometrium without adenomyosis(CE). We found that the mRNA expression of IL-6 and IL-8 in EU was significantly higher than that in CE, and was the highest in EC (P < 0.01). The mRNA and protein expression of TLRs were higher in EU, with the expression of TLR1-6, 8 and 9 being significantly higher in EU than in CE, and were the highest in EC (except TLR6) (P < 0.05 or P < 0.01). Pearson correlation analysis showed that the expression of TLR1, 2, 4, 5 and 9 in EU and EC was positively correlated with that of IL-6 and IL-8 (P < 0.00139). This study suggested that adenomyosis was a state of inflammatory pathology. High expression of TLRs in EU and EC were positively correlated with IL-6 and IL-8, which may be involved in the inflammatory pathogenesis of adenomyosis.
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Affiliation(s)
- Caixia Jiang
- Department of Gynecology and Obstetrics, Yangpu Hospital, Tongji University School of Medicine, 450 Teng Yue Road, Shanghai, 200090, China
| | - Chao Liu
- Department of Gynecology and Obstetrics, Yangpu Hospital, Tongji University School of Medicine, 450 Teng Yue Road, Shanghai, 200090, China
| | - Jing Guo
- Department of Gynecology and Obstetrics, Yangpu Hospital, Tongji University School of Medicine, 450 Teng Yue Road, Shanghai, 200090, China
| | - Li Chen
- Department of Gynecology and Obstetrics, Yangpu Hospital, Tongji University School of Medicine, 450 Teng Yue Road, Shanghai, 200090, China
| | - Ning Luo
- Department of Gynecology and Obstetrics, Yangpu Hospital, Tongji University School of Medicine, 450 Teng Yue Road, Shanghai, 200090, China
| | - Xiaoyan Qu
- Department of Gynecology and Obstetrics, Yangpu Hospital, Tongji University School of Medicine, 450 Teng Yue Road, Shanghai, 200090, China
| | - Weihong Yang
- Department of Gynecology and Obstetrics, Yangpu Hospital, Tongji University School of Medicine, 450 Teng Yue Road, Shanghai, 200090, China
| | - Qing Ren
- Department of Gynecology and Obstetrics, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 280 Mo He Road, Shanghai, 201999, China
| | - Zhongping Cheng
- Department of Gynecology and Obstetrics, Yangpu Hospital, Tongji University School of Medicine, 450 Teng Yue Road, Shanghai, 200090, China.
- Institute of Gynecological Minimal Invasive Medicine, Tongji university School of Medicine, 450 Teng Yue Road, Shanghai, 200090, China.
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Wu J, Xie H, Yao S, Liang Y. Macrophage and nerve interaction in endometriosis. J Neuroinflammation 2017; 14:53. [PMID: 28288663 PMCID: PMC5351283 DOI: 10.1186/s12974-017-0828-3] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 02/28/2017] [Indexed: 12/28/2022] Open
Abstract
Dysregulation of the immune system in endometriotic milieus has been considered to play a pivotal role in the pathogenesis of endometriosis. Macrophage recruitment and nerve fiber infiltration are the two major characteristics of this aberrant immune environment. First, the recruitment of macrophages and their polarization phenotype within the endometriotic lesion have been demonstrated to facilitate the development and maintenance of endometriosis. M1 phenotype of macrophages has the capacity to secrete multiple cytokines for inflammatory response, while M2 macrophage possesses an opposite property that can mediate the process of immunosuppression and neuroangiogenesis. Upon secretion of multiple abnormal signal molecules by the endometriotic lesion, macrophages could alter their location and phenotype. These changes facilitate the accommodation of the aberrant microenvironment and the exacerbation of disease progression. Second, the infiltration of nerve fibers and their abnormal distribution are proved to be involved in the generation of endometriosis-associated pain and inflammatory response. An imbalance in sensory and sympathetic innervation and the abnormal secretion of different cytokines could mediate neurogenesis and subsequent peripheral neuroinflammation in endometriosis. Although endometriosis creates an inflammatory milieu promoting macrophage infiltration and an imbalanced innervation, interaction between macrophages and nerve fibers in this process remains unknown. The aim of this review is to highlight the role of macrophage and nerve interaction in endometriosis, where macrophage recruitment and neurogenesis can be the underlying mechanism of neuroinflammation and pathogenesis of endometriosis.
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Affiliation(s)
- Jinjie Wu
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510089 China
| | - Hongyu Xie
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510089 China
| | - Shuzhong Yao
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Sun Yat-sen University, No. 58, the 2nd Zhongshan Road, Yuexiu District, Guangzhou, 510080 Guangdong Province China
| | - Yanchun Liang
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Sun Yat-sen University, No. 58, the 2nd Zhongshan Road, Yuexiu District, Guangzhou, 510080 Guangdong Province China
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Research development of a new GnRH antagonist (Elagolix) for the treatment of endometriosis: a review of the literature. Arch Gynecol Obstet 2017; 295:827-832. [PMID: 28255765 DOI: 10.1007/s00404-017-4328-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 02/13/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE Limitated studies have reported the efficacy of GnRH antagonist on endometriosis symptoms. The aim of our study was to review all available trials to investigate the medical treatment of endometriosis with only GnRH antagonists, with special attention to pharmacodynamic activity, safety, and efficacy. METHODS Pub Med and Sciencedirect database were searched using terms of "endometriosis treatment", "GnRH antagonist", and "Elagolix". The search was limited to clinical studies published in English. Title and abstract were screened to identify relevant articles. RESULTS Five studies covering use of GnRH antagonist were found. A phase 1 study evaluated the safety, pharmacokinetics, and inhibitory effects on gonadotropins and estradiol of single dose and 7 day elagolix administration to healthy premenopausal women; two phase II studies evaluated efficacy in patient with endometriosis. Moreover, there are two Phase III clinical trials just completed. CONCLUSION GnRH antagonists may have the advantage of oral administration and lower incidence of adverse events. Currently, only Phase II studies have been published demonstrating promising results in terms of efficacy, safety, and tolerability. From the results of the phase III studies, elagolix may become a valuable addition to the armamentarium of pharmacological agents to treat endometriosis-related pain.
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