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Slayden OD, Luo F, Martin D V M LD. A protocol for creating endometriosis in rhesus macaques (Macaca mulatta). J Med Primatol 2023; 52:405-413. [PMID: 37849073 PMCID: PMC10843508 DOI: 10.1111/jmp.12681] [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: 09/12/2023] [Revised: 10/02/2023] [Accepted: 10/09/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Endometriosis is the presence of endometrium-like tissue outside the uterine cavity. An experimental model of endometriosis has been created in the baboon by the transcervical collection and laparoscopic inoculation of menstrual endometrium. Macaques are the preferred model for pharmaceutical development, but the complex anatomy of the macaque cervix makes the baboon method impractical. In this work, we sought to validate a surgical approach for creating endometriosis in macaques. METHODS Menstrual endometrium was collected via laparoscopic intrauterine puncture and transferred to the peritoneal cavity. We repeated this procedure during three menstruations. Endometriotic tissue was identified during laparoscopy, collected, and characterized by immunohistochemistry. RESULTS Sham surgery-treated animals (n = 3) failed to develop endometriosis. We identified red, powder burnt, and white lesions in 13/14 of the treated animals; the stroma of the red lesions stained positive for ovarian steroid receptors. CONCLUSION This surgical technique can reliably create hormone-responsive endometriosis in macaques for therapeutic studies.
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Affiliation(s)
- Ov D Slayden
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Beaverton, Oregon, USA
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Fangzhou Luo
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Beaverton, Oregon, USA
| | - Lauren D Martin D V M
- Division of Animal Resources & Research Support, Oregon National Primate Research Center, Beaverton, Oregon, USA
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2
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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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3
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Chaggar P, Tellum T, Thanatsis N, De Braud LV, Setty T, Jurkovic D. Prevalence of deep and ovarian endometriosis in women attending a general gynecology clinic: prospective cohort study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:632-641. [PMID: 36776112 DOI: 10.1002/uog.26175] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 12/28/2022] [Accepted: 01/23/2023] [Indexed: 05/04/2023]
Abstract
OBJECTIVES To assess using transvaginal ultrasound the prevalence of deep and ovarian endometriosis in premenopausal women attending a general gynecology clinic. We also investigated whether the presence of endometriosis was associated with various demographic factors and other pelvic abnormalities. METHODS This was a prospective observational cohort study carried out between February 2019 and October 2020. Consecutive premenopausal women who attended our general gynecology clinic underwent pelvic ultrasound examination, performed by a single experienced operator. Pregnant women and those with a history of hysterectomy or oophorectomy were excluded. The primary outcome was the prevalence of deep and/or ovarian endometriosis. Secondary outcomes were the anatomical distribution of endometriotic lesions and the association of endometriosis with demographic characteristics and various pelvic abnormalities, which were analyzed using logistic regression and multivariable analysis. RESULTS A total of 1026 women were included in the final study sample, of whom 194 (18.9% (95% CI, 16.6-21.4%)) had sonographic evidence of deep and/or ovarian endometriosis. Of the 194 women diagnosed with endometriosis, 106 (54.6% (95% CI, 47.4-61.8%)) were diagnosed with endometriotic nodules only, 26 (13.4% (95% CI, 9.0-19.0%)) with ovarian endometriomas only, and 62 (32.0% (95% CI, 25.5-39.0%)) women had evidence of both. There was a total of 348 endometriotic nodules in 168 women, located most frequently in the retrocervical area (166/348; 47.7% (95% CI, 42.4-53.1%)), uterosacral ligaments (96/348; 27.6% (95% CI, 23.0-32.6%)) and bowel (40/348; 11.5% (95% CI, 8.3-15.3%)). Multivariable analysis found significant positive associations between endometriosis and both adenomyosis (odds ratio (OR), 1.72 (95% CI, 1.10-2.69); P = 0.02) and pelvic adhesions (OR, 25.7 (95% CI, 16.7-39.3); P < 0.001), whilst higher parity (OR, 0.44 (95% CI, 0.24-0.81); P = 0.03) and history of Cesarean section (OR, 0.18 (95% CI, 0.06-0.52); P = 0.002) were associated with a lower occurrence of endometriosis. A total of 75/1026 women (7.3% (95% CI, 5.8-9.1%)) underwent laparoscopy within 6 months of pelvic ultrasound examination. There was very good agreement between ultrasound and surgical findings, with a kappa value of 0.84 (95% CI, 0.69-0.99). CONCLUSIONS Deep and/or ovarian endometriosis was present in nearly one in five women attending a general gynecology clinic. There were significant positive associations with adenomyosis and pelvic adhesions and negative associations with higher parity and previous Cesarean section. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- P Chaggar
- Institute for Women's Health, University College Hospital, London, UK
| | - T Tellum
- Institute for Women's Health, University College Hospital, London, UK
- Department of Gynaecology, Oslo University Hospital, Oslo, Norway
| | - N Thanatsis
- Institute for Women's Health, University College Hospital, London, UK
| | - L V De Braud
- Institute for Women's Health, University College Hospital, London, UK
| | - T Setty
- Institute for Women's Health, University College Hospital, London, UK
| | - D Jurkovic
- Institute for Women's Health, University College Hospital, London, UK
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4
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Millischer AE, Santulli P, Da Costa S, Bordonne C, Cazaubon E, Marcellin L, Chapron C. Adolescent endometriosis: prevalence increases with age on magnetic resonance imaging scan. Fertil Steril 2023; 119:626-633. [PMID: 36592649 DOI: 10.1016/j.fertnstert.2022.12.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 12/26/2022] [Accepted: 12/28/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To evaluate the prevalence on magnetic resonance imaging (MRI) of ovarian endometrioma (OMA) and deep infiltrating endometriosis (DIE) in adolescents presenting with severe dysmenorrhea. DESIGN Prospective study. SETTING Clinic. PATIENT(S) A total of 345 adolescents aged 12-20 years referred to the radiologic MRI department unit between September 2019 and June 2020. INTERVENTION(S) Multiplanar pelvic MRI with cine MRI was performed. Data on the medical history with systematic questioning were collected for each patient before the scan. MAIN OUTCOME MEASURE(S) Data on the endometriosis phenotypes (OMA and/or DIE), distribution of anatomical lesions, and adenomyosis were evaluated and recorded using a dedicated MRI spreadsheet. Myometrial contractions were systematically reported for each case. The data were correlated with the characteristics of the patients and severity of painful symptoms evaluated using a visual analog scale. RESULT(S) The prevalence rates of endometriosis and adenomyosis were 39.3% (121 patients) and 11.4% (35 patients), respectively. Among the adolescents with endometriosis, 25 (20.7%) presented with OMA, and 107 (88.4%) presented with DIE. The odds ratios (confidence intervals) for each pairwise comparison between the age distributions were 2.3 (1.4-3.8) for 15-18 vs. <15 years of age and 3.3 (1.2-8.5) for 18-20 vs. <15 years of age, highlighting a predominance of cases after 18 years of age. Uterine contractions were visualized in 34.4% of cases, with no particular association with endometriosis. No clinical risk factor was identified as being particularly associated with endometriosis. Notably, the visual analog scale score was the same for cases with and without endometriosis. CONCLUSION(S) Severe endometriosis phenotypes (OMA and/or DIE) can be observed in adolescents with intense dysmenorrhea, with a linear increase in prevalence over time resulting in a clear predominance after 18 years of age. Endometriosis in adolescents is a challenging clinical problem with a long delay in diagnosis. Imaging can help reduce this delay in young patients with suggestive symptoms. CLINICAL TRIAL REGISTRATION NUMBER NCT05153512.
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Affiliation(s)
- Anne-Elodie Millischer
- Imagerie Médicale Paris Centre (IMPC) Bachaumont-IFEEN - Ramsay Santé, Centre de Radiologie, Paris, France; Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Paris, France; Pediatric Radiology Department (Prof. Boddaert), Centre Hospitalier Universitaire (CHU) Necker, Paris, France.
| | - Pietro Santulli
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Paris, France; Faculté de Médecine Paris Centre, Université de Paris, Faculté de Santé, Paris, France; Department of Gynecology Obstetrics II and Reproductive Medicine (Prof. Chapron), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France; Department of "Development, Reproduction and Cancer," Institut Cochin, INSERM U1016, Paris, France
| | - Sabrina Da Costa
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Paris, France; Pediatric Gynecology Department (Prof. Polak), Centre Hospitalier Universitaire (CHU) Necker, Paris, France
| | - Corinne Bordonne
- Imagerie Médicale Paris Centre (IMPC) Bachaumont-IFEEN - Ramsay Santé, Centre de Radiologie, Paris, France; Department of Radiology (Prof. Dion), Centre Hospitalier Universitaire (CHU) Hôtel Dieu, Paris, France
| | - Elise Cazaubon
- IQVIA statistic Real World Solutions, Biometric, Paris, France
| | - Louis Marcellin
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Paris, France; Faculté de Médecine Paris Centre, Université de Paris, Faculté de Santé, Paris, France; Department of Gynecology Obstetrics II and Reproductive Medicine (Prof. Chapron), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France; Department of "Development, Reproduction and Cancer," Institut Cochin, INSERM U1016, Paris, France
| | - Charles Chapron
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Paris, France; Faculté de Médecine Paris Centre, Université de Paris, Faculté de Santé, Paris, France; Department of Gynecology Obstetrics II and Reproductive Medicine (Prof. Chapron), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France; Department of "Development, Reproduction and Cancer," Institut Cochin, INSERM U1016, Paris, France
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5
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Zare M, Hesampour F, Poordast T, Valibeigi M, Enayatmehri M, Ahmadi S, Nasri F, Gharesi-Fard B. Association between gene polymorphisms of IL-12, IL-12 receptor and IL-27 and organ involvement in Iranian endometriosis patients. Int J Immunogenet 2023; 50:24-33. [PMID: 36328955 DOI: 10.1111/iji.12606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/07/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
Endometriosis is an inflammatory disease characterized by the presence of ectopic endometrial tissue, immune cell dysfunction and abnormal cytokine secretion. In addition to immunological factors, genetic variations that influence endometriosis severity and cytokine expression levels play important roles in the pathogenesis of this disease. Interleukin-12 (IL-12), specifically its p40 subunit encoded by IL-12B gene and the interleukin-12 receptor β1 (IL-12Rβ2) chain of its receptor, as well as interleukin-27 (IL-27) are important in the establishment of endometriosis. So, in this study, we measured IL-12 and IL-27 serum levels and investigated the possible links between IL-12B rs3212227, IL-12Rβ2 rs3790565 and IL-27 rs153109 polymorphisms and the risk of developing endometriosis in a group of Iranian women. In this case-control study, 162 endometriosis patients and 151 healthy women were included and tested for the aforementioned polymorphisms using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. The enzyme-linked immunosorbent assay (ELISA) method was also used to measure IL-12 and IL-27 serum levels. Although there was no statistically significant association between the genotypes and alleles of the studied polymorphisms and the development of endometriosis in general, the AA genotype of IL-12B rs3212227 showed a significant association with uterine endometriosis when compared to AC+CC genotypes (p = .04, CI = 0.270-0.988, OR = 0.517). Indeed, the AA genotype of the IL-12B rs3212227 single nucleotide polymorphism (SNP) may be linked with a lower risk of developing uterine endometriosis. There was no significant difference in IL-27 levels between the two studied groups (p = .49), and IL-12 levels were undetectable in both groups. In conclusion, the AA genotype of IL-12B rs3212227 might be associated with a decreased risk of uterine involvement in endometriosis patients.
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Affiliation(s)
- Maryam Zare
- Department of Immunology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Faculty of Medicine, Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Canada
| | - Fatemeh Hesampour
- Department of Immunology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Rady Faculty of Health Science, Department of Immunology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, R3E0T5, Canada
| | - Tahereh Poordast
- Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Valibeigi
- Department of Immunology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maliheh Enayatmehri
- Department of Immunology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sahar Ahmadi
- Department of Immunology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Nasri
- Department of Laboratory Sciences, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.,Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Behrouz Gharesi-Fard
- Department of Immunology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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6
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Rickard BP, Conrad C, Sorrin AJ, Ruhi MK, Reader JC, Huang SA, Franco W, Scarcelli G, Polacheck WJ, Roque DM, del Carmen MG, Huang HC, Demirci U, Rizvi I. Malignant Ascites in Ovarian Cancer: Cellular, Acellular, and Biophysical Determinants of Molecular Characteristics and Therapy Response. Cancers (Basel) 2021; 13:4318. [PMID: 34503128 PMCID: PMC8430600 DOI: 10.3390/cancers13174318] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/17/2021] [Accepted: 08/22/2021] [Indexed: 12/27/2022] Open
Abstract
Ascites refers to the abnormal accumulation of fluid in the peritoneum resulting from an underlying pathology, such as metastatic cancer. Among all cancers, advanced-stage epithelial ovarian cancer is most frequently associated with the production of malignant ascites and is the leading cause of death from gynecologic malignancies. Despite decades of evidence showing that the accumulation of peritoneal fluid portends the poorest outcomes for cancer patients, the role of malignant ascites in promoting metastasis and therapy resistance remains poorly understood. This review summarizes the current understanding of malignant ascites, with a focus on ovarian cancer. The first section provides an overview of heterogeneity in ovarian cancer and the pathophysiology of malignant ascites. Next, analytical methods used to characterize the cellular and acellular components of malignant ascites, as well the role of these components in modulating cell biology, are discussed. The review then provides a perspective on the pressures and forces that tumors are subjected to in the presence of malignant ascites and the impact of physical stress on therapy resistance. Treatment options for malignant ascites, including surgical, pharmacological and photochemical interventions are then discussed to highlight challenges and opportunities at the interface of drug discovery, device development and physical sciences in oncology.
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Affiliation(s)
- Brittany P. Rickard
- Curriculum in Toxicology & Environmental Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC, and North Carolina State University, Raleigh, NC 27599, USA; (M.K.R.); (S.A.H.); (W.J.P.)
| | - Christina Conrad
- Fischell Department of Bioengineering, University of Maryland, College Park, MD 20742, USA; (C.C.); (A.J.S.); (G.S.); (H.-C.H.)
| | - Aaron J. Sorrin
- Fischell Department of Bioengineering, University of Maryland, College Park, MD 20742, USA; (C.C.); (A.J.S.); (G.S.); (H.-C.H.)
| | - Mustafa Kemal Ruhi
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC, and North Carolina State University, Raleigh, NC 27599, USA; (M.K.R.); (S.A.H.); (W.J.P.)
| | - Jocelyn C. Reader
- Department of Obstetrics, Gynecology and Reproductive Medicine, School of Medicine, University of Maryland, Baltimore, MD 21201, USA; (J.C.R.); (D.M.R.)
- Marlene and Stewart Greenebaum Cancer Center, School of Medicine, University of Maryland, Baltimore, MD 21201, USA
| | - Stephanie A. Huang
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC, and North Carolina State University, Raleigh, NC 27599, USA; (M.K.R.); (S.A.H.); (W.J.P.)
| | - Walfre Franco
- Department of Biomedical Engineering, University of Massachusetts Lowell, Lowell, MA 01854, USA;
| | - Giuliano Scarcelli
- Fischell Department of Bioengineering, University of Maryland, College Park, MD 20742, USA; (C.C.); (A.J.S.); (G.S.); (H.-C.H.)
| | - William J. Polacheck
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC, and North Carolina State University, Raleigh, NC 27599, USA; (M.K.R.); (S.A.H.); (W.J.P.)
- Department of Cell Biology and Physiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Dana M. Roque
- Department of Obstetrics, Gynecology and Reproductive Medicine, School of Medicine, University of Maryland, Baltimore, MD 21201, USA; (J.C.R.); (D.M.R.)
- Marlene and Stewart Greenebaum Cancer Center, School of Medicine, University of Maryland, Baltimore, MD 21201, USA
| | - Marcela G. del Carmen
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA;
| | - Huang-Chiao Huang
- Fischell Department of Bioengineering, University of Maryland, College Park, MD 20742, USA; (C.C.); (A.J.S.); (G.S.); (H.-C.H.)
- Marlene and Stewart Greenebaum Cancer Center, School of Medicine, University of Maryland, Baltimore, MD 21201, USA
| | - Utkan Demirci
- Bio-Acoustic MEMS in Medicine (BAMM) Laboratory, Canary Center at Stanford for Cancer Early Detection, Department of Radiology, School of Medicine, Stanford University, Palo Alto, CA 94304, USA;
| | - Imran Rizvi
- Curriculum in Toxicology & Environmental Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC, and North Carolina State University, Raleigh, NC 27599, USA; (M.K.R.); (S.A.H.); (W.J.P.)
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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7
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Ma J, Zhang L, Zhan H, Mo Y, Ren Z, Shao A, Lin J. Single-cell transcriptomic analysis of endometriosis provides insights into fibroblast fates and immune cell heterogeneity. Cell Biosci 2021; 11:125. [PMID: 34233737 PMCID: PMC8261960 DOI: 10.1186/s13578-021-00637-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/25/2021] [Indexed: 02/06/2023] Open
Abstract
Background Endometriosis is an oestrogen-dependent disease with an unclear aetiology and pathogenesis affecting 6–10% of the global female population, predominantly those of reproductive age. Herein, we profile the transcriptomes of approximately 55,000 single cells from three groups including ectopic endometrium, eutopic endometrium from women with endometriosis, and eutopic endometrium from healthy women to create a single-cell transcriptome atlas of endometriosis. Results We have identified 9 cell types and performed single-cell analysis of fibroblasts, and determined a potential developmental trajectory associated with endometriosis. We also identified fibroblast subpopulations related to endometriosis development and found that StAR played an important role in this process. Moreover, T cells in endometriosis were less activated or inflammatory with decreased effector CD8 + T cells, while the composition ratio of natural killer cells decreased and the percentage of monocytes/macrophages increased in endometriosis cysts. In addition, the effectiveness of immune cells in endometriosis lesions, eutopic endometrium from women with endometriosis, and eutopic endometrium from healthy women was distinct. Cell–cell interaction analyses highlighted the imbalanced immune environment in endometriosis lesions and immune cells in endometriosis could promote the development of the disease. Conclusion Our study provided a systematic characterisation of endometriosis and insights into the aetiology and pathology of endometriosis. Supplementary Information The online version contains supplementary material available at 10.1186/s13578-021-00637-x.
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Affiliation(s)
- Junyan Ma
- Key Laboratory of Women's Reproductive Health Research of Zhejiang Province, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Liqi Zhang
- Department of Obstetrics and Gynecology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hong Zhan
- Department of Obstetrics and Gynecology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yun Mo
- Department of Obstetrics and Gynecology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zuanjie Ren
- Department of Obstetrics and Gynecology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Anwen Shao
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jun Lin
- Key Laboratory of Women's Reproductive Health Research of Zhejiang Province, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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8
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Just PA, Moret S, Borghese B, Chapron C. [Endometriosis and adenomyosis]. Ann Pathol 2021; 41:521-534. [PMID: 34183193 DOI: 10.1016/j.annpat.2021.03.012] [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: 10/08/2020] [Revised: 03/10/2021] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Abstract
Diffuse adenomyosis, focal adenomyosis, ovarian endometrioma, superficial endometriosis and deep infiltrating adenomyosis are all defined by the presence of an endometrioid tissue in an ectopic location that is at distance from the endometrium. Although frequently associated, these lesions represent different clinico-pathological entities that the pathologist should recognized. Herein, we review the clinical and pathological features of these entities, as well as related current physiopathological understandings and differential diagnoses that could be raised by some morphological variants. The statistical association between endometriosis and several ovarian tumors, mainly endometrioid and clear cell carcinomas and seromucinous borderline tumors is well established and we present some molecular and morphological features that support this transformation potential.
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Affiliation(s)
- Pierre-Alexandre Just
- Université de Paris, service de pathologie, AP-HP, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
| | - Sandrine Moret
- Université de Paris, service de pathologie, AP-HP, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Bruno Borghese
- Université de Paris, service de gynécologie obstétrique 2 et médecine de la reproduction, AP-HP, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Charles Chapron
- Université de Paris, service de gynécologie obstétrique 2 et médecine de la reproduction, AP-HP, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
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9
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Klebanoff JS, Inaty D, Rahman S, Habib N, Bendifallah S, Ayoubi JM, Moawad GN. Appropriate surgical management of ovarian endometrioma: excision or drainage? Horm Mol Biol Clin Investig 2021; 43:127-135. [PMID: 33600671 DOI: 10.1515/hmbci-2020-0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 02/03/2021] [Indexed: 11/15/2022]
Abstract
Endometriosis negatively impacts the lives of countless women around the world. When medical management fails to improve quality of life often women are left making a decision whether or not to proceed with surgery. With endometriomas, patient's surgical options include complete surgical removal or drainage via laparoscopy. Here, we review the literature to discuss both techniques, excision and drainage of endometriomas, and what the research supports for endometrioma management.
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Affiliation(s)
- Jordan S Klebanoff
- Department of Obstetrics and Gynecology, Main Line Health, Wynewood, PA, USA
| | - Dana Inaty
- University of Balamand School of Medicine, Balamand, Lebanon
| | - Sara Rahman
- Department of Obstetrics and Gynecology, The George Washington University Hospital, Washington, DC, USA
| | - Nassir Habib
- Department of Obstetrics and Gynecology, Francois Quesnay Hospital, Mantes-la-Jolie, France
| | - Sofiane Bendifallah
- Department of Gynaecology and Obstetrics, University of Balamand School of Medicine, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Sorbonne, France.,UMRS-938, Sorbonne University, Sorbonne, France.,Groupe de Recherche Clinique 6 (GRC6-Sorbonne Université): Centre Expert En Endométriose (C3E), Sorbonne, France
| | - Jean Marc Ayoubi
- Department of Obstetrics and Gyncology and Reproductive Medicine, Hopital Foch, Faculté de Médecine Paris Ouest (UVSQ), Suresnes, France
| | - Gaby N Moawad
- Department of Obstetrics and Gynecology, The George Washington University Hospital, Washington, DC, USA
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10
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Velagapudi RK, Egan JP. Thoracic Endometriosis: a Clinical Review and Update of Current and Evolving Diagnostic and Therapeutic Techniques. CURRENT PULMONOLOGY REPORTS 2021. [DOI: 10.1007/s13665-021-00269-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Abstract
Purpose of Review
The goal of this review is to provide a comprehensive understanding of the pathophysiology, clinical presentation, diagnostic workup, and clinical management of thoracic endometriosis (TE), as well as highlight our personal experience with TE workup and management.
Recent Findings
TE can present in a wide range of clinical manifestations. Without high clinical suspicion, diagnosis can be delayed. Since no specific laboratory testing is available, diagnosis is often based on careful history taking, imaging, and direct visualization of endometrial lesions through video-assisted thoracoscopic surgery (VATS). Medical thoracoscopy (MT) may also be a useful tool in the diagnostic workup of TE.
Summary
The diagnosis and management of TE require a multidisciplinary approach and a high index of clinical suspicion. While VATS remains the gold standard for diagnosis, we share our experience using MT to diagnose and manage a case of TE-related hemothorax.
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11
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Brunty S, Mitchell B, Bou-Zgheib N, Santanam N. Endometriosis and ovarian cancer risk, an epigenetic connection. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1715. [PMID: 33490227 PMCID: PMC7812227 DOI: 10.21037/atm-20-2449] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Endometriosis is a gynecological disorder that affects 176 million women worldwide and 1 in 10 females in the United States. Endometriosis most often affects women of child-bearing age, with most going undiagnosed. Endometriosis also shares many characteristics common to invasive cancer and has been known to be associated with epithelial ovarian cancer. Ovarian cancer is the 11th most common cancer among women and over 22,000 new cases will be diagnosed within the next year. Women most commonly diagnosed with this cancer are between the ages of 55–64 years, outside the range of the age of women affected with endometriosis. While no known cause of either disease has been established, epigenetic regulation is thought to play a major role in both. This review focuses on epigenetic changes that occur within each individual disease as well as those that are similar in both, suggesting a possible etiological link between the two diseases.
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Affiliation(s)
- Sarah Brunty
- Department of Biomedical Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, USA
| | - Brenda Mitchell
- Department of Obstetrics and Gynecology, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, USA
| | - Nadim Bou-Zgheib
- Department of Obstetrics and Gynecology, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, USA
| | - Nalini Santanam
- Department of Biomedical Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, USA
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12
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Fontoura Oliveira A, Ferreira H. Neovagina creation in congenital vaginal agenesis: New mini-laparoscopic approach applying intraoperative indocyanine green fluorescence. Surg Innov 2020; 28:24-32. [PMID: 33124521 DOI: 10.1177/1553350620968990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background. There is still no standardized treatment for vaginal agenesis; surgical repair using a minimally invasive technique is a good option, as it offers rapid results along with a fast postoperative recovery. Objective. To describe a new modified Vecchietti procedure by a mini-laparoscopic approach with intraoperative use of indocyanine green fluorescence technology for the creation of a neovagina in the setting of congenital vaginal agenesis. Methods. Retrospective review of all cases of congenital vaginal agenesis submitted to a mini-laparoscopic modified Vecchietti procedure with intraoperative use of indocyanine green (ICG) fluorescence (between June and September 2019). Patient relevant medical history, surgical technique, postoperative care, outcomes, and complications are described. Results. Four patients with Mayer-Rokitansky-Küster-Hauser syndrome (mean age: 19 years; mean preoperative vaginal length: 1.5 cm) were included in the study. The procedure was completed successfully and uneventfully in all patients. External traction device was removed 5-7 days after surgery and replaced by external vaginal silicone dilators. This technique was able to create 10-11 cm neovaginas in 1 week; six weeks after surgery all patients had an epithelized 10.5-12 cm length and 2.5-3 cm diameter neovagina. Complications consisted of one case of isolated fever at the ninth postoperative day, solved with empiric antibiotic treatment. Conclusion. The mini-laparoscopic modified Vecchietti approach, associated with ICG fluorescence imaging, is feasible and effective in the treatment of congenital vaginal agenesis, as it is a simple and safe procedure with promising outcomes.
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Affiliation(s)
- Andreia Fontoura Oliveira
- Minimally Invasive Gynecology Department, 522166Centro Hospitalar Universitário do Porto EPE-Centro Materno Infantil do Norte, Portugal.,Department of Gynecology and Obstetrics, 466971Centro Hospitalar do Médio Ave EPE, Santo Tirso, Porto, Portugal
| | - Hélder Ferreira
- Minimally Invasive Gynecology Department, 522166Centro Hospitalar Universitário do Porto EPE-Centro Materno Infantil do Norte, Portugal.,89239University of Porto-Instituto de Ciências Biomédicas Abel Salazar, Portugal
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13
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Liu Y, Liang S, Yang F, Sun Y, Niu L, Ren Y, Wang H, He Y, Du J, Yang J, Lin J. Biological characteristics of endometriotic mesenchymal stem cells isolated from ectopic lesions of patients with endometriosis. Stem Cell Res Ther 2020; 11:346. [PMID: 32771033 PMCID: PMC7414689 DOI: 10.1186/s13287-020-01856-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/29/2020] [Accepted: 07/27/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Research into the pathogenesis of endometriosis (EMs) would substantially promote its effective treatment and early diagnosis. However, the aetiology of EMs is poorly understood and controversial despite the progress in EMs research in the last several decades. Currently, accumulating evidence has shed light on the importance of endometrial stem cells (EnSCs) residing in the basal layer of endometrium in the establishment and progression of endometriotic lesions. Therefore, we aimed to identify the differences between EnSCs isolated from the ectopic lesions of EMs patients (EnSC-EM-EC) and EnSCs isolated from eutopic endometrium of control group (EnSC-Control). We further performed preliminary exploration of the potential signalling pathways involved in the above abnormalities. METHODS EnSC-EM-EC (n = 12) and EnSC-Control (n = 13) were successfully isolated. Then, the proliferative capacity, migratory capacity and angiogenic potential of EnSCs were evaluated by conventional MTT assay, flow cytometry, wound healing assay, transwell assay, tube formation assay and chick embryo chorioallantoic membrane assay respectively. The expression of 11 angiogenesis-associated biological factors and 11 cytokines secreted by EnSCs and 17 adhesion molecules expressed on EnSCs were determined by protein array assays respectively. Differentially expressed genes (DEGs) between EnSC-EM-EC and EnSC-Control were analysed by RNA-sequence. RESULTS EnSC-EM-EC exhibited unique biological characteristics, including prolonged mitosis, enhanced migratory capacity and enhanced angiogenic potential. Greater amounts of angiogenic factors (especially VEGF and PDGF) were secreted by EnSC-EM-EC than by EnSC-Control; however, the distinct profiles of cytokines secreted by EnSC-EM-EC and adhesion molecules expressed by EnSC-EM-EC require further investigation. A total of 523 DEGs between EnSC-EM-EC and EnSC-Control were identified and analysed using the KEGG and Gene Ontology databases. CONCLUSIONS Our results not only improve the understanding of EMs but also contribute to the development of EnSC-EM-EC as a tool for EMs drug discovery. These cells could be of great help in exploiting promising therapeutic targets and new biomarkers for EMs treatment and prognosis.
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Affiliation(s)
- Yanli Liu
- Stem Cell and Biotherapy Technology Research Center, College of Life Science and Technology, Xinxiang Medical University, Xinxiang, 453003, China.,Henan Key Laboratory of Medical Tissue Regeneration, NO 601, East of JinSui Road, Xinxiang City, 453003, Henan Province, China
| | - Shengying Liang
- Stem Cell and Biotherapy Technology Research Center, College of Life Science and Technology, Xinxiang Medical University, Xinxiang, 453003, China.,Henan Key Laboratory of Medical Tissue Regeneration, NO 601, East of JinSui Road, Xinxiang City, 453003, Henan Province, China
| | - Fen Yang
- Stem Cell and Biotherapy Technology Research Center, College of Life Science and Technology, Xinxiang Medical University, Xinxiang, 453003, China.,Henan Key Laboratory of Medical Tissue Regeneration, NO 601, East of JinSui Road, Xinxiang City, 453003, Henan Province, China.,College of Biomedical Engineering, Xinxiang Medical University, Xinxiang, 453003, China
| | - Yuliang Sun
- Stem Cell and Biotherapy Technology Research Center, College of Life Science and Technology, Xinxiang Medical University, Xinxiang, 453003, China
| | - Lidan Niu
- Stem Cell and Biotherapy Technology Research Center, College of Life Science and Technology, Xinxiang Medical University, Xinxiang, 453003, China.,College of Biomedical Engineering, Xinxiang Medical University, Xinxiang, 453003, China
| | - Yakun Ren
- Stem Cell and Biotherapy Technology Research Center, College of Life Science and Technology, Xinxiang Medical University, Xinxiang, 453003, China.,Henan Key Laboratory of Medical Tissue Regeneration, NO 601, East of JinSui Road, Xinxiang City, 453003, Henan Province, China
| | - Hongmei Wang
- The First Affiliated Hospital of Xinxiang Medical University, NO 88, JianKang Road, Weihui, Xinxiang City, 453100, Henan Province, China
| | - Yanan He
- Stem Cell and Biotherapy Technology Research Center, College of Life Science and Technology, Xinxiang Medical University, Xinxiang, 453003, China
| | - Jiang Du
- Stem Cell and Biotherapy Technology Research Center, College of Life Science and Technology, Xinxiang Medical University, Xinxiang, 453003, China.,College of Biomedical Engineering, Xinxiang Medical University, Xinxiang, 453003, China
| | - Jun Yang
- The First Affiliated Hospital of Xinxiang Medical University, NO 88, JianKang Road, Weihui, Xinxiang City, 453100, Henan Province, China.
| | - Juntang Lin
- Stem Cell and Biotherapy Technology Research Center, College of Life Science and Technology, Xinxiang Medical University, Xinxiang, 453003, China. .,Henan Key Laboratory of Medical Tissue Regeneration, NO 601, East of JinSui Road, Xinxiang City, 453003, Henan Province, China.
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14
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Kwok H, Jiang H, Li T, Yang H, Fei H, Cheng L, Yao S, Chen S. Lesion distribution characteristics of deep infiltrating endometriosis with ovarian endometrioma: an observational clinical study. BMC WOMENS HEALTH 2020; 20:111. [PMID: 32434535 PMCID: PMC7240912 DOI: 10.1186/s12905-020-00974-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 05/10/2020] [Indexed: 01/07/2023]
Abstract
Background To investigate the characteristics of deep infiltrating endometriosis (DIE) lesion distribution when associated with ovarian endometrioma (OEM). Methods The present study analyzed retrospective data obtained by the First Affiliated Hospital of Sun Yat-sen University, between June 2008 to June 2016. A total of 304 patients underwent laparoscopic surgery for complete removal of endometriosis by one experienced surgeon, and histological confirmation of OEM associated with DIE was conducted for each patient. Clinical data were recorded for each patient from medical, operative and pathological reports. Patients were then divided into two groups according to unilateral or bilateral OEM. Patients with unilateral OEM were subsequently divided into two subgroups according to OEM location (left- or right-hand side) and the diameter of the OEM (≤50 and > 50 mm). The distribution characteristics of DIE lesions were then compared between the groups. Results DIE lesions were widely distributed, 30 anatomical sites were involved. Patients with associated unilateral OEM (n = 184 patients) had a significantly increased number of DIE lesions when compared with patients with bilateral OEM (n = 120 patients; 2.76 ± 1.52 vs. 2.33 ± 1.34; P = 0.006). Compared with bilateral OEM with DIE, there was a higher rate of intestinal (39.1% vs. 18.3%; P < 0.01) and vaginal (17.4% vs. 6.7%; P < 0.01) infiltration by DIE lesions in unilateral OEM with DIE. The mean number of DIE lesions was not significantly correlated with the location or size of the OEM (2.83 ± 1.56 vs. 2.74 ± 1.53; P = 0.678; and 2.65 ± 1.42 vs. 2.80 ± 1.43; P = 0.518, respectively). There was no significant difference between the groups with OEM ≤50 mm and > 50 mm. Conclusion Lesion distribution characteristics in women diagnosed with histologically proven OEM associated with DIE were frequently multifocal and severe.
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Affiliation(s)
- Hungling Kwok
- Department of Obstetrics and Gynecology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Hongye Jiang
- Department of Obstetrics and Gynecology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510000, China
| | - Tian Li
- Department of Obstetrics and Gynecology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Huan Yang
- Department of Gynecology, Shenzhen Second People's Hospital/ the First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Hui Fei
- Department of Obstetrics and Gynecology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Li Cheng
- Department of Obstetrics and Gynecology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Shuzhong Yao
- Department of Obstetrics and Gynecology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510000, China
| | - Shuqin Chen
- Department of Obstetrics and Gynecology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510000, China.
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15
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Montoya-Estrada A, Coria-García CF, Cruz-Orozco OP, Aguayo-González P, Torres-Ramos YD, Flores-Herrera H, Hicks JJ, Medina-Navarro R, Guzmán-Grenfell AM. Increased systemic and peritoneal oxidative stress biomarkers in endometriosis are not related to retrograde menstruation. Redox Rep 2020; 24:51-55. [PMID: 31221043 PMCID: PMC6748618 DOI: 10.1080/13510002.2019.1632603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Objetives: The goal of this study was to determine if systemic and peritoneal oxidative stress biomarkers are related to each other and to retrograde menstruation in endometriosis. Methods: Plasma and peritoneal fluid oxidative stress biomarkers and hemoglobin and erythrocytes in peritoneal fluid as retrograde menstruation indicators, were measured in 28 patients with endometriosis and 23 without endometriosis. Results: In the peritoneal fluid, carbonyls and lipohydroperoxides, indicative of protein and lipid oxidative damage, were higher in endometriosis group (21%, p = 0.016 and 46%, p = 0.009, respectively). However, these biomarkers were not different in the blood plasma of both groups, and only protein dityrosine, was increased in the plasma of endometriosis group (31%, p = 0.04). The peritoneal fluid hemoglobin content was not higher in the endometriosis group, nor related to carbonyls and lipohydroperoxides. Additionally, the peritoneal fluid oxidative biomarkers were not correlated with the blood plasma ones, and only malondialdehyde, and ischemia-modified albumin were almost two times higher in peritoneal fluid. Discussion: Our results show a peritoneal and systemic oxidative stress biomarkers increase in endometriosis, but not related to each other, and do not support the hypothesis of an increase in hemoglobin-iron supply towards the peritoneal cavity that causes oxidative damage.
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Affiliation(s)
- Araceli Montoya-Estrada
- a Departamento de Inmunobioqímica , Instituto Nacional de Perinatología 'Isidro Espinosa de los Reyes' , Ciudad de México , México
| | - Cynthia F Coria-García
- a Departamento de Inmunobioqímica , Instituto Nacional de Perinatología 'Isidro Espinosa de los Reyes' , Ciudad de México , México
| | - Oliver P Cruz-Orozco
- a Departamento de Inmunobioqímica , Instituto Nacional de Perinatología 'Isidro Espinosa de los Reyes' , Ciudad de México , México
| | - Patricia Aguayo-González
- a Departamento de Inmunobioqímica , Instituto Nacional de Perinatología 'Isidro Espinosa de los Reyes' , Ciudad de México , México
| | - Yessica D Torres-Ramos
- a Departamento de Inmunobioqímica , Instituto Nacional de Perinatología 'Isidro Espinosa de los Reyes' , Ciudad de México , México
| | - Héctor Flores-Herrera
- a Departamento de Inmunobioqímica , Instituto Nacional de Perinatología 'Isidro Espinosa de los Reyes' , Ciudad de México , México
| | - Juan J Hicks
- b Comisión Coordinadora de los Institutos Nacionales de Salud y Hospitales de Alta Especialidad , Ciudad de México , México
| | - Rafael Medina-Navarro
- c Departamento de Metabolismo Experimental , Centro de Investigación Biomédica de Michoacán (CIBIM-IMSS) , Morelia , México
| | - Alberto M Guzmán-Grenfell
- a Departamento de Inmunobioqímica , Instituto Nacional de Perinatología 'Isidro Espinosa de los Reyes' , Ciudad de México , México
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16
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Raimondo D, Mattioli G, Casadio P, Borghese G, Ambrosio M, Arena A, Paradisi R, Del Forno S, Coppola F, Valerio D, Garattoni M, Golfieri R, Seracchioli R. Frequency and clinical impact of Dolichocolon in women submitted to surgery for rectosigmoid endometriosis. J Gynecol Obstet Hum Reprod 2020; 49:101697. [PMID: 32018043 DOI: 10.1016/j.jogoh.2020.101697] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 12/25/2019] [Accepted: 01/24/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Rectosigmoid endometriosis and Dolichocolon can both present with a triad of chronic abdominal pain, constipation and bloating. The relationship between these two pathologies is unknown. The present study aims to determine the frequency of DC in women with rectosigmoid endometriosis and its possible impact on pre- and post-operative symptoms. MATERIAL AND METHODS We conducted a retrospective cohort study on 113 consecutive patients submitted to magnetic resonance imaging enema and subsequent complete surgical removal for symptomatic rectosigmoid endometriosis between June 2015 to June 2018. Dolichocolon is an anatomic variant characterized by redundancies and lengthening of the colon. We divided our study population according to its presence or absence. The two groups were compared in terms of demographic data, surgical findings and pre- and post-operative clinical variables. Pain symptoms were assessed through numerical rating scale from 0 to 10. Bowel complaints included constipation, bloating and diarrhea. RESULTS Thirty-five patients (31 %) presented a dolichocolon at magnetic resonance imaging enema. The two groups were comparable in terms of demographic data, pre-operative clinical variables and surgical findings. At 6-month follow-up, there was a significant improvement of symptoms, except for constipation and bloating in dolichocolon group. In particular, we observed with a statistical difference (p < .05) the persistence of constipation and bloating in dolichocolon group compared to non-dolichocolon group. CONCLUSIONS Dolichocolon was observed in one third patients with rectosigmoid endometriosis and could influence surgical outcomes for rectosigmoid endometriosis in terms of relief of bowel symptoms.
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Affiliation(s)
- Diego Raimondo
- Department of Obstetrics and Gynecology, DIMEC, S. Orsola Hospital, University of Bologna, Italy
| | - Giulia Mattioli
- Department of Obstetrics and Gynecology, DIMEC, S. Orsola Hospital, University of Bologna, Italy.
| | - Paolo Casadio
- Department of Obstetrics and Gynecology, DIMEC, S. Orsola Hospital, University of Bologna, Italy
| | - Giulia Borghese
- Department of Obstetrics and Gynecology, DIMEC, S. Orsola Hospital, University of Bologna, Italy
| | - Marco Ambrosio
- Department of Obstetrics and Gynecology, DIMEC, S. Orsola Hospital, University of Bologna, Italy
| | - Alessandro Arena
- Department of Obstetrics and Gynecology, DIMEC, S. Orsola Hospital, University of Bologna, Italy
| | - Roberto Paradisi
- Department of Obstetrics and Gynecology, DIMEC, S. Orsola Hospital, University of Bologna, Italy
| | - Simona Del Forno
- Department of Obstetrics and Gynecology, DIMEC, S. Orsola Hospital, University of Bologna, Italy
| | - Francesca Coppola
- Radiology Unit, Department of Digestive Disease and Internal Medicine, DIMES, S. Orsola Hospital, University of Bologna, Italy
| | - Domenico Valerio
- Radiology Unit, Department of Digestive Disease and Internal Medicine, DIMES, S. Orsola Hospital, University of Bologna, Italy
| | - Monica Garattoni
- Radiology Unit, Department of Digestive Disease and Internal Medicine, DIMES, S. Orsola Hospital, University of Bologna, Italy
| | - Rita Golfieri
- Radiology Unit, Department of Digestive Disease and Internal Medicine, DIMES, S. Orsola Hospital, University of Bologna, Italy
| | - Renato Seracchioli
- Department of Obstetrics and Gynecology, DIMEC, S. Orsola Hospital, University of Bologna, Italy
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17
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Gil Y, Tulandi T. Diagnosis and Treatment of Catamenial Pneumothorax: A Systematic Review. J Minim Invasive Gynecol 2020; 27:48-53. [DOI: 10.1016/j.jmig.2019.08.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 07/30/2019] [Accepted: 08/04/2019] [Indexed: 01/07/2023]
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18
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Chapron C, Marcellin L, Borghese B, Santulli P. Rethinking mechanisms, diagnosis and management of endometriosis. Nat Rev Endocrinol 2019; 15:666-682. [PMID: 31488888 DOI: 10.1038/s41574-019-0245-z] [Citation(s) in RCA: 424] [Impact Index Per Article: 84.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2019] [Indexed: 02/08/2023]
Abstract
Endometriosis is a chronic inflammatory disease defined as the presence of endometrial tissue outside the uterus, which causes pelvic pain and infertility. This disease should be viewed as a public health problem with a major effect on the quality of life of women as well as being a substantial economic burden. In light of the considerable progress with diagnostic imaging (for example, transvaginal ultrasound and MRI), exploratory laparoscopy should no longer be used to diagnose endometriotic lesions. Instead, diagnosis of endometriosis should be based on a structured process involving the combination of patient interviews, clinical examination and imaging. Notably, a diagnosis of endometriosis often leads to immediate surgery. Therefore, rethinking the diagnosis and management of endometriosis is warranted. Instead of assessing endometriosis on the day of the diagnosis, gynaecologists should consider the patient's 'endometriosis life'. Medical treatment is the first-line therapeutic option for patients with pelvic pain and no desire for immediate pregnancy. In women with infertility, careful consideration should be made regarding whether to provide assisted reproductive technologies prior to performing endometriosis surgery. Modern endometriosis management should be individualized with a patient-centred, multi-modal and interdisciplinary integrated approach.
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Affiliation(s)
- Charles Chapron
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France.
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynecology Obstetrics II and Reproductive Medicine, Paris, France.
- Department 'Development, Reproduction and Cancer', Institut Cochin, INSERM U1016, Université Paris Descartes, Paris, France.
| | - Louis Marcellin
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynecology Obstetrics II and Reproductive Medicine, Paris, France
- Department 'Development, Reproduction and Cancer', Institut Cochin, INSERM U1016, Université Paris Descartes, Paris, France
| | - Bruno Borghese
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynecology Obstetrics II and Reproductive Medicine, Paris, France
- Department 'Development, Reproduction and Cancer', Institut Cochin, INSERM U1016, Université Paris Descartes, Paris, France
| | - Pietro Santulli
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynecology Obstetrics II and Reproductive Medicine, Paris, France
- Department 'Development, Reproduction and Cancer', Institut Cochin, INSERM U1016, Université Paris Descartes, Paris, France
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19
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Marcellin L, Leconte M, Gaujoux S, Santulli P, Borghese B, Chapron C, Dousset B. Associated ileocaecal location is a marker for greater severity of low rectal endometriosis. BJOG 2019; 126:1600-1608. [DOI: 10.1111/1471-0528.15901] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2019] [Indexed: 12/23/2022]
Affiliation(s)
- L Marcellin
- Département de Gynécologie Obsétrique II et Médecine de la Reproduction (Professeur Chapron) Assistance Publique‐Hôpitaux de Paris (AP‐HP) Centre Hospitalier Universitaire (CHU) Cochin Hôpital Universitaire Paris Centre (HUPC) Paris France
- Université Paris Descartes Sorbonne Paris Cité Paris France
| | - M Leconte
- Université Paris Descartes Sorbonne Paris Cité Paris France
- Service de Chirurgie Digestive Hépato‐biliaire et Endocrinienne Assistance, Publique‐Hôpitaux de Paris (AP‐HP) Centre Hospitalier Universitaire (CHU) Cochin Hôpital Universitaire, Paris Centre (HUPC) Paris France
| | - S Gaujoux
- Université Paris Descartes Sorbonne Paris Cité Paris France
- Service de Chirurgie Digestive Hépato‐biliaire et Endocrinienne Assistance, Publique‐Hôpitaux de Paris (AP‐HP) Centre Hospitalier Universitaire (CHU) Cochin Hôpital Universitaire, Paris Centre (HUPC) Paris France
| | - P Santulli
- Département de Gynécologie Obsétrique II et Médecine de la Reproduction (Professeur Chapron) Assistance Publique‐Hôpitaux de Paris (AP‐HP) Centre Hospitalier Universitaire (CHU) Cochin Hôpital Universitaire Paris Centre (HUPC) Paris France
- Université Paris Descartes Sorbonne Paris Cité Paris France
| | - B Borghese
- Département de Gynécologie Obsétrique II et Médecine de la Reproduction (Professeur Chapron) Assistance Publique‐Hôpitaux de Paris (AP‐HP) Centre Hospitalier Universitaire (CHU) Cochin Hôpital Universitaire Paris Centre (HUPC) Paris France
- Université Paris Descartes Sorbonne Paris Cité Paris France
| | - C Chapron
- Département de Gynécologie Obsétrique II et Médecine de la Reproduction (Professeur Chapron) Assistance Publique‐Hôpitaux de Paris (AP‐HP) Centre Hospitalier Universitaire (CHU) Cochin Hôpital Universitaire Paris Centre (HUPC) Paris France
- Université Paris Descartes Sorbonne Paris Cité Paris France
| | - B Dousset
- Université Paris Descartes Sorbonne Paris Cité Paris France
- Service de Chirurgie Digestive Hépato‐biliaire et Endocrinienne Assistance, Publique‐Hôpitaux de Paris (AP‐HP) Centre Hospitalier Universitaire (CHU) Cochin Hôpital Universitaire, Paris Centre (HUPC) Paris France
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Denny E, Weckesser A, Jones G, Bibila S, Daniels J, Bhattacharya S. Women's experiences of medical treatment for endometriosis and its impact on PRE-EMPT trial participation: a qualitative study. Pilot Feasibility Stud 2018; 4:168. [PMID: 30410786 PMCID: PMC6217778 DOI: 10.1186/s40814-018-0358-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 10/15/2018] [Indexed: 01/25/2023] Open
Abstract
Background Endometriosis is a common cause of chronic pelvic pain which can relapse after surgery, yet little research has been conducted on women's experience of medical treatments for prevention of recurrence and the influence of this on participation in clinical trials. Methods This study explored women's past experiences with medical treatments for endometriosis symptoms and the impact this has on their motivation to enter the pilot phase of a post-conservative surgery clinical trial, PRE-EMPT: Preventing Recurrence of Endometriosis by Means of long acting Progestogen Therapy. Qualitative methodology was adopted, involving semi-structured interviews in three UK cities, and one focus group was used to collect data from women with a diagnosis of endometriosis participating in the PRE-EMPT trial. Results Ten women were interviewed individually and four took part in the focus group discussion. Women's willingness to enter the PRE-EMPT trial was bound up with their previous experiences, present situation and future expectations of medication, as well as the control offered by flexible randomisation which allows the option to reject a particular treatment post-surgery. Conclusion Women were strongly influenced by previous experience and personal circumstances in their decision to enter the PRE-EMPT trial. This decision was facilitated by the ability to 'opt out' of the treatment arm(s) they found unacceptable. This element of choice offered patients a sense of control in the randomisation process and has important implications for clinical trial design and recruitment. Trial registration ISRCTN97865475. EUDRACT number 2013-001984-21.
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Affiliation(s)
- Elaine Denny
- 1Centre for Social Care, Health and Related Research, Faculty of Health, Education and Life Sciences, Birmingham City University, Westbourne Rd, Edgbaston, Birmingham B15 3TN UK
| | - Annalise Weckesser
- 1Centre for Social Care, Health and Related Research, Faculty of Health, Education and Life Sciences, Birmingham City University, Westbourne Rd, Edgbaston, Birmingham B15 3TN UK
| | - Georgina Jones
- 2School of Social Sciences, Leeds Beckett University, Leeds, LS1 9HE UK
| | - Stavroula Bibila
- 3Coventry University Group, Armstrong Siddeley Building, Gosford St., Coventry, CV1 5DL UK
| | - Jane Daniels
- 4Nottingham Clinical Trials Unit, Queen's Medical Centre, C Floor, South Block, Nottingham, NG7 2UH UK
| | - Siladitya Bhattacharya
- Institute of Applied Health Sciences, School of Medicine, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD UK
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Isaza-Restrepo A, Martin-Saavedra JS, Velez-Leal JL, Vargas-Barato F, Riveros-Dueñas R. The Peritoneum: Beyond the Tissue - A Review. Front Physiol 2018; 9:738. [PMID: 29962968 PMCID: PMC6014125 DOI: 10.3389/fphys.2018.00738] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 05/28/2018] [Indexed: 12/15/2022] Open
Abstract
Background: Despite its complexity, the peritoneum is usually underestimated in classical medical texts simply as the surrounding tissue (serous membrane) of the gut. Novel findings on physiology and morphology of the peritoneum and mesothelial cell exist but they are usually focused or limited to Continuous Ambulatory Peritoneal Dialysis research and practice. This review aims to expose, describe and analyze the most recent evidence on the peritoneum’s morphology, embryology and physiology. Materials and Methods: A literature review was performed on Pubmed and MEDLINE. With no limit of publication date, original papers and literature reviews about the peritoneum, the peritoneal cavity, peritoneal fluid, and mesothelial cells were included (n = 72). Results: Peritoneum develops in close relationship to the gut from an early period in embryogenesis. Analyzing together the development of the primitive gut and the surrounding mesothelium helps understanding that the peritoneal cavity, the mesenteries and other structures can be considered parts of the peritoneum. However, some authors consider that structures like the mesenteries are different to the peritoneum. The mesothelial cell has a complex ultrastructural organization with intercellular junctions and apical microvilli. This complexity is further proven by the large array of functions like selective fluid and cell transport; physiological protective barrier; immune induction, modulation, and inhibition; tissue repair and scarring; preventing adhesion and tumoral dissemination; cellular migration; and the epithelial-mesenchymal transition capacity. Conclusion: Recent evidence on the anatomy, histology, and physiology of the peritoneum, shows that this structure is more complex than a simple serous membrane. These results call for a new conceptualization of peritoneum, and highlight the need of adequate research for identifying clinical relevance of this knowledge.
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Affiliation(s)
- Andres Isaza-Restrepo
- Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia.,Department of Clinical Surgery, Hospital Universitario Mayor - Méderi, Bogotá, Colombia
| | - Juan S Martin-Saavedra
- Clinical Research Group, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Juan L Velez-Leal
- Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Felipe Vargas-Barato
- Department of Clinical Surgery, Hospital Universitario Mayor - Méderi, Bogotá, Colombia
| | - Rafael Riveros-Dueñas
- Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
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Pelzer ES, Willner D, Buttini M, Hafner LM, Theodoropoulos C, Huygens F. The fallopian tube microbiome: implications for reproductive health. Oncotarget 2018; 9:21541-21551. [PMID: 29765558 PMCID: PMC5940370 DOI: 10.18632/oncotarget.25059] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 03/21/2018] [Indexed: 02/07/2023] Open
Abstract
Objective There is a paucity of data characterizing the microbiota of the female upper genital tract, which controversially is described as a sterile site. We examine whether the fallopian tube harbours an endogenous microbial community. Design This prospective study collected from women undergoing total hysterectomy or salpingectomy-oophorectomy. Setting Private hospital gynaecology department. Patients Fallopian tubes were collected from women diagnosed with benign disease or for prophylaxis. Interventions Samples were interrogated for the presence of microbial DNA using a next generation sequencing technology approach to exploit the V5 to V9 regions of the 16S rRNA gene. Main outcome measures The fallopian tube microbiota was characterized using traditional culture techniques and next generation sequencing. Results Bacteria were isolated from 50% of cultured samples, and 100% of samples returned positive PCR results. Only 68% of the culture isolates could be confidently identified using automated diagnostic equipment in a clinical microbiology laboratory. Monomicrobial communities were identified only for cultured isolates (50%). Pyrosequencing revealed that all communities were polymicrobial. Lactobacillus spp. were not present in all groups, nor were they the most dominant isolates. Distinct differences in the microbial communities were evident for left compared to right fallopian tubes, ampulla versus isthmus, pre- and post- menopausal tissue, and in secretory phase fallopian tubes with and without Mirena intrauterine devices in situ (all p < 0.05). Conclusion The female upper genital tract is not sterile. Distinct microbial community profiles in the fallopian tubes of healthy women suggest that this genital tract site supports an endogenous microbiota.
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Affiliation(s)
- Elise S Pelzer
- Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, 4001 Australia.,The Wesley Research Institute, Women's Health Laboratory, The Wesley Hospital, Auchenflower, Queensland, 4066 Australia
| | - Dana Willner
- The Australian Centre for Ecogenomics, St Lucia, Queensland, 4067 Australia
| | - Melissa Buttini
- The Wesley Hospital, Auchenflower, Queensland, 4066 Australia
| | - Louise M Hafner
- Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, 4001 Australia
| | - Christina Theodoropoulos
- Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, 4001 Australia
| | - Flavia Huygens
- Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, 4001 Australia
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24
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Borghese B, Santulli P, Marcellin L, Chapron C. [Definition, description, clinicopathological features, pathogenesis and natural history of endometriosis: CNGOF-HAS Endometriosis Guidelines]. ACTA ACUST UNITED AC 2018. [PMID: 29540335 DOI: 10.1016/j.gofs.2018.02.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Endometriosis and adenomyosis are histologically defined. The frequency of endometriosis cannot be precisely estimated in the general population. Endometriosis is considered a disease when it causes pain and/or infertility. Endometriosis is a heterogeneous disease with three well-recognized subtypes that are often associated with each other: superficial endometriosis (SUP), ovarian endometrioma (OMA), and deep infiltrating endometriosis (DIE). DIE is frequently multifocal and mainly affects the following structures: the uterosacral ligaments, the posterior vaginal cul-de-sac, the bladder, the ureters, and the digestive tract (rectum, recto-sigmoid junction, appendix). The role of menstrual reflux in the pathophysiology of endometriosis is major and explains the asymmetric distribution of lesions, which predominate in the posterior compartment of the pelvis and on the left (NP3). All factors favoring menstrual reflux increase the risk of endometriosis (early menarche, short cycles, AUB, etc.). Inflammation and biosteroid hormones synthesis are the main mechanisms favoring the implantation and the growth of the lesions. Pain associated with endometriosis can be explained by nociception, hyperalgia, and central sensitization, associated to varying degrees in a single patient. Typology of pain (dysmenorrhea, deep dyspareunia, digestive or urinary symptoms) is correlated with the location of the lesions. Infertility associated with endometriosis can be explained by several non-exclusive mechanisms: a pelvic factor (inflammation), disrupting natural fertilization; an ovarian factor, related to oocyte quality and/or quantity; a uterine factor disrupting implantation. The pelvic factor can be fixed by surgical excision of the lesions that improves the chance of natural conception (NP2). The uterine factor can be corrected by an ovulation-blocking treatment that improves the chances of getting pregnant by in vitro fertilization (NP2). The impact of endometrioma exeresis on the ovarian reserve (NP2) should be considered when a surgery is scheduled. Endometriosis is a multifactorial disease, resulting from combined action of genetic and environmental factors. The risk of developing endometriosis for a first-degree relative is five times higher than in the general population (NP2). Identification of genetic variants involved in the disease has no implication for clinical practice for the moment. The role of environmental factors, particularly endocrine disrupters, is plausible but not demonstrated. Literature review does not support the progression of endometriosis over time, either in terms of the volume or the number of the lesions (NP3). The risk of acute digestive occlusion or functional loss of a kidney in patients followed for endometriosis seems exceptional. These complications were revealing the disease in the majority of cases. IVF does not increase the intensity of pain associated with endometriosis (NP2). There is few data on the influence of pregnancy on the lesions, except the possibility of a decidualization of the lesions that may give them a suspicious aspect on imaging. The impact of endometriosis on pregnancy is debated. There is an epidemiological association between endometriosis and rare subtypes of ovarian cancer (endometrioid and clear cell carcinomas) (NP2). However, the relative risk is moderate (around 1.3) (NP2) and the causal relationship between endometriosis and ovarian cancer is not demonstrated so far. Considering the low incidence of endometriosis-associated ovarian cancer, there is no argument to propose a screening or a risk reducing strategy for the patients.
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Affiliation(s)
- B Borghese
- Service de chirurgie gynécologie obstétrique 2 et médecine de la reproduction, CHU Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Équipe génomique, épigénétique et physiopathologie de la reproduction, Inserm U1016, département développement, reproduction, cancer, université Paris Descartes, Sorbonne Paris cité, 12, rue de l'École-de-médecine, 75270 Paris cedex 06, France.
| | - P Santulli
- Service de chirurgie gynécologie obstétrique 2 et médecine de la reproduction, CHU Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Équipe génomique, épigénétique et physiopathologie de la reproduction, Inserm U1016, département développement, reproduction, cancer, université Paris Descartes, Sorbonne Paris cité, 12, rue de l'École-de-médecine, 75270 Paris cedex 06, France
| | - L Marcellin
- Service de chirurgie gynécologie obstétrique 2 et médecine de la reproduction, CHU Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Équipe stress oxydant, prolifération cellulaire et inflammation, Inserm U1016, département développement, reproduction, cancer, université Paris Descartes, Sorbonne Paris cité, 12, rue de l'École-de-médecine, 75270 Paris cedex 06, France
| | - C Chapron
- Service de chirurgie gynécologie obstétrique 2 et médecine de la reproduction, CHU Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Équipe génomique, épigénétique et physiopathologie de la reproduction, Inserm U1016, département développement, reproduction, cancer, université Paris Descartes, Sorbonne Paris cité, 12, rue de l'École-de-médecine, 75270 Paris cedex 06, France
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Peritoneal fluid of women with endometriosis reduces SOD1 in bovine oocytes in vitro maturation. Cell Tissue Res 2018; 372:621-628. [DOI: 10.1007/s00441-018-2805-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 01/18/2018] [Indexed: 01/06/2023]
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Tulandi T, Sirois C, Sabban H, Cohen A, Murji A, Singh SS, Chen I, Belland L. Relationship between Catamenial Pneumothorax or Non-catamenial Pneumothorax and Endometriosis. J Minim Invasive Gynecol 2017; 25:480-483. [PMID: 29038042 DOI: 10.1016/j.jmig.2017.10.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 10/04/2017] [Accepted: 10/06/2017] [Indexed: 10/18/2022]
Abstract
STUDY OBJECTIVE To evaluate the clinical characteristics of women presenting with catamenial pneumothorax and compare them with those with noncatamenial pneumothorax. DESIGN A case-control study (Canadian Task Force II-2). SETTING A multicenter study. PATIENTS Forty-two women with pneumothorax: 21 women had catamenial pneumothorax (study group), and 21 were age-matched women with noncatamenial pneumothorax (control group). INTERVENTIONS All patients underwent video-assisted thoracoscopy and pleural biopsy. We also evaluated the presence and stage of pelvic endometriosis in 16 women with catamenial pneumothorax who had undergone laparoscopic surgery. MEASUREMENTS AND MAIN RESULTS The number of known episodes of catamenial pneumothorax before treatment was between 2 and 8 episodes. Symptoms were mainly chest pain and shortness of breath; 1 patient had hemoptysis. The prevalence of right-sided pneumothorax was 95.2% in the study group and 57.1% in the control group (p = .004). Besides 2 cases with complete collapse of the right lung, most of the cases in the study group had apical pneumothorax. Pelvic endometriosis was found in 15 of 16 women (93.7%), mainly stage 3 or 4, and thoracic endometriosis in 12 of 20 women (60%). None of the patients in the control group had thoracic endometriosis. CONCLUSION Thoracic endometriosis is found in over half of women with catamenial pneumothorax but absent in those with noncatamenial pneumothorax. Right apical pneumothorax is predominant in women with catamenial pneumothorax. Endometriosis plays an important role in the mechanism of catamenial pneumothorax.
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Affiliation(s)
- Togas Tulandi
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada.
| | - Christian Sirois
- Department of Thoracic Surgery, McGill University, Montreal, Quebec, Canada
| | - Hussein Sabban
- Department of Obstetrics and Gynecology, King Abdul Aziz University, Saudi Arabia
| | - Aviad Cohen
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
| | - Ally Murji
- University of Toronto, Toronto, Ontario, Canada
| | - Sukhbir S Singh
- University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Innie Chen
- University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Lin LX, Luo JW, Yuan F, Zhang HH, Ye CQ, Zhang P, Sun YL. In situ cross-linking carbodiimide-modified chitosan hydrogel for postoperative adhesion prevention in a rat model. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2017; 81:380-385. [PMID: 28887987 DOI: 10.1016/j.msec.2017.07.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 06/14/2017] [Accepted: 07/15/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Postoperative intra-abdominal adhesion often causes many complications. Chitosan fluid has been used in clinic to prevent intra-abdominal adhesion. However, fluid can be easily diluted and cannot stay on the wound site. As hydrogel is able to form stable physical barrier to separate injured tissues, we developed a chitosan hydrogel for better prevention of intra-abdominal adhesion in this study. METHODS We synthesized a carbodiimide-derivatized chitosan gelatin (cd-CS-gelatin) hydrogel and investigated its rheological properties. A rat model was used to compare the anti-adhesion effect of chitosan hydrogel and fluid. The wounds were created with damage of the underlying muscle of the abdominal wall and the serosal layer of the cecum. They were coated with chitosan fluid or cd-CS-gelatin hydrogel. At day 14 after surgery, the animals were euthanized and intra-abdominal adhesion was assessed. RESULTS The cd-CS-gelatin hydrogel solidified within 3min after the mixing of the reagents. The cecum-abdomen adhesion occurred in all rats without anti-adhesion treatment. The application of cd-CS-gelatin significantly reduced the adhesion rate from 100% to 50%, compared the chitosan fluid only to 88%. The decrease of adhesion breaking strength also manifested that cd-CS-gelatin was more effective than chitosan fluid to reduce postsurgical intra-abdominal adhesion formation. CONCLUSIONS Chitosan hydrogel is more effective than chitosan fluid to prevent postoperative cecum-abdomen adhesion. It indicates that hydrogel could be a more promising state than liquid to prevent postoperative intra-abdominal adhesion.
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Affiliation(s)
- Long-Xiang Lin
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China; Fujian Province University Key Laboratory of Green Energy and Environment Catalysis, Ningde Normal University, Ningde 352100, PR China
| | - Jing-Wan Luo
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Fang Yuan
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Hui-Hui Zhang
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Chen-Qing Ye
- Fujian Province University Key Laboratory of Green Energy and Environment Catalysis, Ningde Normal University, Ningde 352100, PR China
| | - Peng Zhang
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Yu-Long Sun
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
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Chapron C, Tosti C, Marcellin L, Bourdon M, Lafay-Pillet MC, Millischer AE, Streuli I, Borghese B, Petraglia F, Santulli P. Relationship between the magnetic resonance imaging appearance of adenomyosis and endometriosis phenotypes. Hum Reprod 2017; 32:1393-1401. [DOI: 10.1093/humrep/dex088] [Citation(s) in RCA: 128] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 04/23/2017] [Indexed: 01/03/2023] Open
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Rekker K, Saare M, Eriste E, Tasa T, Kukuškina V, Roost AM, Anderson K, Samuel K, Karro H, Salumets A, Peters M. High-throughput mRNA sequencing of stromal cells from endometriomas and endometrium. Reproduction 2017; 154:93-100. [PMID: 28495852 DOI: 10.1530/rep-17-0092] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 04/07/2017] [Accepted: 05/11/2017] [Indexed: 12/15/2022]
Abstract
The aetiology of endometriosis is still unclear and to find mechanisms behind the disease development, it is important to study each cell type from endometrium and ectopic lesions independently. The objective of this study was to uncover complete mRNA profiles in uncultured stromal cells from paired samples of endometriomas and eutopic endometrium. High-throughput mRNA sequencing revealed over 1300 dysregulated genes in stromal cells from ectopic lesions, including several novel genes in the context of endometriosis. Functional annotation analysis of differentially expressed genes highlighted pathways related to cell adhesion, extracellular matrix-receptor interaction and complement and coagulation cascade. Most importantly, we found a simultaneous upregulation of complement system components and inhibitors, indicating major imbalances in complement regulation in ectopic stromal cells. We also performed in vitro experiments to evaluate the effect of endometriosis patients' peritoneal fluid (PF) on complement system gene expression levels, but no significant impact of PF on C3, CD55 and CFH levels was observed. In conclusion, the use of isolated stromal cells enables to determine gene expression levels without the background interference of other cell types. In the future, a new standard design studying all cell types from endometriotic lesions separately should be applied to reveal novel mechanisms behind endometriosis pathogenesis.
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Affiliation(s)
- Kadri Rekker
- Department of Obstetrics and GynecologyInstitute of Clinical Medicine, University of Tartu, Tartu, Estonia .,Competence Centre on Health TechnologiesTartu, Estonia
| | - Merli Saare
- Department of Obstetrics and GynecologyInstitute of Clinical Medicine, University of Tartu, Tartu, Estonia.,Competence Centre on Health TechnologiesTartu, Estonia
| | - Elo Eriste
- Competence Centre on Health TechnologiesTartu, Estonia
| | - Tõnis Tasa
- Institute of Computer ScienceUniversity of Tartu, Tartu, Estonia.,Estonian Genome CenterUniversity of Tartu, Tartu, Estonia
| | - Viktorija Kukuškina
- Estonian Genome CenterUniversity of Tartu, Tartu, Estonia.,Institute of Molecular and Cell BiologyUniversity of Tartu, Tartu, Estonia
| | | | | | - Külli Samuel
- Competence Centre on Health TechnologiesTartu, Estonia
| | - Helle Karro
- Department of Obstetrics and GynecologyInstitute of Clinical Medicine, University of Tartu, Tartu, Estonia.,Tartu University Hospital's Women's ClinicTartu, Estonia
| | - Andres Salumets
- Department of Obstetrics and GynecologyInstitute of Clinical Medicine, University of Tartu, Tartu, Estonia.,Competence Centre on Health TechnologiesTartu, Estonia.,Department of BiomedicineInstitute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia.,Department of Obstetrics and GynecologyUniversity of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maire Peters
- Department of Obstetrics and GynecologyInstitute of Clinical Medicine, University of Tartu, Tartu, Estonia.,Competence Centre on Health TechnologiesTartu, Estonia
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Gonçalves E. ENDOMETRIOSE E AS DOENÇAS AUTO IMUNES: RELATO DE CASO. REVISTA BRASILEIRA DE REUMATOLOGIA 2017. [DOI: 10.1016/j.rbr.2017.07.344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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31
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Eberhardt SC, Strickland CD, Epstein KN. Radiology of epiploic appendages: acute appendagitis, post-infarcted appendages, and imaging natural history. Abdom Radiol (NY) 2016; 41:1653-65. [PMID: 27142382 DOI: 10.1007/s00261-016-0757-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Our aim was to demonstrate the imaging characteristics of epiploic appendages in native, acute inflamed/ischemic and post-infarcted states through retrospective imaging analysis, with clinical and pathologic correlation, and to discuss clinical implications. Cases were gathered mostly retrospectively and reviewed for inclusion based on established diagnostic criteria. Radiology report text search was used to find cases, using terms "epiploic," "appendage," "appendagitis," and "peritoneal body." Data records included patient demographics, relevant clinical data, lesion size, location and apparent imaging composition, and the presence of change or stability in features over multiple studies. Pathologic and clinical data were sought and assessed for correlation. Imaging studies of 198 individuals were included (mean age 50, range 9-95), with a total of 228 lesions: 63 acute and 165 non-acute presentations. All included subjects had CT imaging and some had lesions visible on radiographs, MRI, PET/CT, and sonography. 23 subjects had more than one studied lesion. In addition to classic acute appendagitis, more frequently encountered are post-infarcted appendages either in situ along the colon, adhered to peritoneal or serosal surfaces, or freely mobile in the peritoneum as loose bodies. The majority of the non-acute varieties are recognizable due to peripheral calcification that develops over time following ischemic insult. Multiple cases demonstrated the imaging natural history and confirmed pathologic basis for imaging findings. In summary, acute and post-infarcted epiploic appendages have characteristic imaging appearances and natural history which should provide correct diagnosis in most cases. Incidental post-infarcted epiploica are more commonly encountered than acute presentations.
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Preoperative risk factors in recurrent endometrioma after primary conservative surgery. Obstet Gynecol Sci 2016; 59:286-94. [PMID: 27462595 PMCID: PMC4958674 DOI: 10.5468/ogs.2016.59.4.286] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 12/21/2015] [Accepted: 12/23/2015] [Indexed: 11/13/2022] Open
Abstract
Objective Endometriosis is a common gynecological disorder caused by ectopic implantation of endometrial glandular and stromal cells outside the uterine cavity. Among several types of endometriosis, endometrioma is the only subtype that could be determined preoperatively using pelvic ultrasonography, and guidelines recommend pathologic confirmation of endometrioma greater than 3 cm in diameter. However, although surgery is performed in cases of endometrioma, endometrioma has a high cumulative rate of recurrence. Therefore, because determining the possibility of recurrence before performance of initial surgery is important, we examined preoperative factors associated with recurrent endometrioma. Methods This was a retrospective, comparative study including 236 patients who visited the outpatient clinic between January 2009 and December 2011. Patients who were pathologically diagnosed with endometrioma were included in this study. They were followed up postoperatively and were divided into two groups according to presence of recurrent endometrioma. Results We examined associations between baseline factors and recurrent endometrioma. In multivariate analysis, dysmenorrhea and cyst septation were statistically significant after adjusting with age, parity, surgical staging and postoperative management. We examined cumulative recurrence free survival within cases of recurrent endometriosis, based on the presence of inner cyst septation. The cumulative recurrence free survival was lower in cases with septation. Conclusion Our study found that recurrent endometrioma is more likely in patients with inner cyst septation and the recurrence occurred within a shorter duration of time than in patients without inner cyst septation on preoperative ultrasonography. Therefore intensive caution and postoperative long term medical therapy would be appropriate in patients with inner cyst septation on preoperative ultrasonography before undergoing primary surgery for endometrioma.
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Genipin-crosslinked gelatin microspheres as a strategy to prevent postsurgical peritoneal adhesions: In vitro and in vivo characterization. Biomaterials 2016; 96:33-46. [DOI: 10.1016/j.biomaterials.2016.04.012] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 04/11/2016] [Accepted: 04/13/2016] [Indexed: 01/27/2023]
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Cimsit C, Yoldemir T, Akpinar IN. Sciatic neuroendometriosis: Magnetic resonance imaging defined perineural spread of endometriosis. J Obstet Gynaecol Res 2016; 42:890-894. [DOI: 10.1111/jog.12998] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 01/27/2016] [Accepted: 02/18/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Canan Cimsit
- Department of Radiology; Marmara University Training and Research Hospital; Istanbul Turkey
| | - Tevfik Yoldemir
- Department of Radiology; Marmara University Training and Research Hospital; Istanbul Turkey
| | - Ihsan Nuri Akpinar
- Department of Radiology; Marmara University Training and Research Hospital; Istanbul Turkey
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Rousset P, Gregory J, Rousset-Jablonski C, Hugon-Rodin J, Regnard JF, Chapron C, Coste J, Golfier F, Revel MP. MR diagnosis of diaphragmatic endometriosis. Eur Radiol 2016; 26:3968-3977. [PMID: 26868500 DOI: 10.1007/s00330-016-4226-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 01/05/2016] [Accepted: 01/15/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate magnetic resonance imaging (MRI) for diaphragmatic endometriosis diagnosis. MATERIALS AND METHODS Over a 2-year period, all diaphragmatic MRI performed in the context of diaphragmatic endometriosis were reviewed. Axial and coronal fat-suppressed T1- and T2-weighted sequences were analyzed by two independent readers for the presence of nodules, plaque lesions, micronodule clustering, or focal liver herniation. MR abnormalities were correlated to surgical findings in women surgically treated. Interobserver agreement was assessed by κ statistics. RESULTS Twenty-three women with diaphragmatic endometriosis criteria comprised the population; 14 had surgical confirmation and nine had symptoms relief with hormonal treatment. MRI sensitivity was 83 % (19/23; 95 % confidence interval [CI]: 68, 98) for reader 1 and 78 % (18/23; 95 % CI: 61, 95) for reader 2. Kappa value was 0.86 (95 % CI: 0.47, 1.00). Readers 1 and 2 detected 35 and 36 lesions, respectively, all right-sided and agreed for 32 lesions on the type, location, and signal. Lesions were mostly nodules (23/32, 72 %), predominantly posterior (28/32, 87.5 %) and hyperintense on T1 (20/32, 63 %). MRI was negative for both readers in 2 surgically treated patients with small nodules or isolated diaphragmatic holes. CONCLUSION MRI allows diaphragmatic endometriosis diagnosis with 78 to 83 % sensitivity and excellent interobserver agreement. KEY POINTS • MRI allows the diagnosis of diaphragmatic endometriosis with up to 83 % sensitivity. • Diaphragmatic endometriosis lesions are better depicted on fat-suppressed T1-weighted sequences. • Diaphragmatic lesions, mostly hyperintense nodules, are right-sided and predominantly posterior. • MRI can help in timely diagnosis of diaphragmatic endometriosis.
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Affiliation(s)
- Pascal Rousset
- Lyon 1 Claude Bernard University, Villeurbanne, France. .,Radiology Department, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France.
| | - Jules Gregory
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Biostatistics and Epidemiology department, Groupe Hospitalier Cochin Hôtel-Dieu, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Christine Rousset-Jablonski
- Obstetric and Gynecologic Department, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France
| | - Justine Hugon-Rodin
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Gynecology Endocrinology Department, Groupe Hospitalier Cochin Hôtel-Dieu, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Jean-François Regnard
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Thoracic Surgery Department, Groupe Hospitalier Cochin Hôtel-Dieu, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Charles Chapron
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Obstetric and Gynecologic Department, Groupe Hospitalier Cochin Hôtel-Dieu, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Joël Coste
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Biostatistics and Epidemiology department, Groupe Hospitalier Cochin Hôtel-Dieu, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - François Golfier
- Lyon 1 Claude Bernard University, Villeurbanne, France.,Obstetric and Gynecologic Department, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France
| | - Marie-Pierre Revel
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Radiology Department, Groupe Hospitalier Cochin Hôtel-Dieu, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
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Slayden OD. Translational In Vivo Models for Women's Health: The Nonhuman Primate Endometrium--A Predictive Model for Assessing Steroid Receptor Modulators. Handb Exp Pharmacol 2016; 232:191-202. [PMID: 26721679 DOI: 10.1007/164_2015_22] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Macaques and baboons display physiological responses to steroid hormones that are similar to those of women. Herein, we describe various uses of nonhuman primates for preclinical studies on menstruation, endometriosis, and as a model system to evaluate reproductive therapies and contraceptives. Our goal is to outline the strengths of the nonhuman primate model for studies leading to improved therapies for women.
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Affiliation(s)
- Ov Daniel Slayden
- Division of Reproductive Sciences, Oregon National Primate Research Center, Oregon Health and Science University, 505 N.W. 185th Ave., Beaverton, OR, 97006, USA.
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Dyson MT, Kakinuma T, Pavone ME, Monsivais D, Navarro A, Malpani SS, Ono M, Bulun SE. Aberrant expression and localization of deoxyribonucleic acid methyltransferase 3B in endometriotic stromal cells. Fertil Steril 2015; 104:953-963.e2. [PMID: 26239024 PMCID: PMC4603532 DOI: 10.1016/j.fertnstert.2015.06.046] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 06/30/2015] [Accepted: 06/30/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To define the expression and function of DNA methyltransferases (DNMTs) in response to decidualizing stimuli in endometriotic cells compared with healthy endometrial stroma. DESIGN Basic science. SETTING University research center. PATIENT(S) Premenopausal women with or without endometriosis. INTERVENTION(S) Primary cultures of stromal cells from healthy endometrium (E-IUM) or endometriomas (E-OSIS) were subjected to in vitro decidualization (IVD) using 1 μM medroxyprogesterone acetate, 35 nM 17β-estradiol, and 0.05 mM 8-Br-cAMP. MAIN OUTCOME MEASURE(S) Expression of DNMT1, DNMT3A, and DNMT3B in E-IUM and E-OSIS were assessed by quantitative real-time polymerase chain reaction and immunoblotting. Recruitment of DNMT3B to the promoters of steroidogenic factor 1 (SF-1) and estrogen receptor α (ESR1) was examined by chromatin immunoprecipitation. RESULT(S) IVD treatment reduced DNMT3B messenger RNA (74%) and protein levels (81%) only in E-IUM; DNMT1 and DNMT3A were unchanged in both cell types. Significantly more DNMT3B bound to the SF-1 promoter in E-IUM compared with E-OSIS, and IVD treatment reduced binding in E-IUM to levels similar to those in E-OSIS. Enrichment of DNMT3B across 3 ESR1 promoters was reduced in E-IUM after IVD, although the more-distal promoter showed increased DNMT3B enrichment in E-OSIS after IVD. CONCLUSION(S) The inability to downregulate DNMT3B expression in E-OSIS may contribute to an aberrant epigenetic fingerprint that misdirects gene expression in endometriosis and contributes to its altered response to steroid hormones.
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Affiliation(s)
- Matthew T Dyson
- Division of Reproductive Biology Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Toshiyuki Kakinuma
- Division of Reproductive Biology Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mary Ellen Pavone
- Division of Reproductive Biology Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Diana Monsivais
- Division of Reproductive Biology Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Antonia Navarro
- Division of Reproductive Biology Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Saurabh S Malpani
- Division of Reproductive Biology Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Masanori Ono
- Division of Reproductive Biology Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Serdar E Bulun
- Division of Reproductive Biology Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Bassi MA, Arias V, D'Amico Filho N, Gueuvoghlanian-Silva BY, Abrao MS, Podgaec S. Deep Invasive Endometriosis Lesions of the Rectosigmoid May Be Related to Alterations in Cell Kinetics. Reprod Sci 2015; 22:1122-8. [PMID: 25721913 DOI: 10.1177/1933719115574341] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of this study was to analyze cell kinetics through expression and apoptosis of topoisomerase 2-α (TOP2A), p53, and c-erb2 in rectosigmoid endometriotic lesions and in healthy endometrial tissue and to establish correlations between such findings and clinical data in patients with rectosigmoid endometriosis. METHODS Sixty patients with rectosigmoid endometriosis and 20 control women without endometriosis were included. Immunohistochemical assays were used to measure expression of TOP2A, p53, and c-erB-2. Apoptosis was quantified by directly counting the apoptotic bodies. FINDINGS The number of lesions was positively correlated with expression of TOP2A in the lesion. There was also significant correlation between the lesions' size and number and cell turnover index. Apoptosis index (AI) was the same for endometriosis lesions and eutopic endometrium. Expression of TOP2A was significantly lower in the endometriosis group compared to the controls. CONCLUSIONS Changes in cell proliferation but not in the AI in rectosigmoid endometriosis are indicative of an imbalance in cell kinetics that may lead to the development of the disease.
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Affiliation(s)
- Marco Antonio Bassi
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Sao Paulo, São Paulo, Brazil
| | - Victor Arias
- Department of Pathology, Perola Byington Hospital, São Paulo, Brazil
| | | | | | - Mauricio Simoes Abrao
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Sao Paulo, São Paulo, Brazil
| | - Sergio Podgaec
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Sao Paulo, São Paulo, Brazil Jewish Teaching and Research Institute, Albert Einstein Hospital, São Paulo, Brazil
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Association of history of surgery for endometriosis with severity of deeply infiltrating endometriosis. Obstet Gynecol 2015; 124:709-717. [PMID: 25198269 DOI: 10.1097/aog.0000000000000464] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To assess whether a history of surgery for endometriosis could be considered as a marker for disease severity. METHODS This cross-sectional study included 780 women with histologically proven endometriosis who underwent surgery. We compared 309 patients with a history of surgery for endometriosis (study group) with 471 patients who did not receive prior surgical intervention (control group). Multivariate logistic regression was performed to assess the risk of deeply infiltrating endometriosis (defined by invasion of the muscularis by endometriotic tissue). RESULTS Patients with a history of surgery displayed an increased prevalence of deeply infiltrating endometriosis (242 patients [78.3%] compared with 210 patients [44.6%], respectively; P<.001). Moreover, the study group showed significantly higher stage, mean total (P<.001), and mean adhesions (P<.001) scores based on the American Society for Reproductive Medicine classification system. Furthermore, history of previous surgery remained independently associated with the presence of deeply infiltrating endometriosis (compared with superficial endometriosis and ovarian endometrioma grouped together) in multivariate regression analysis, which adjusted for preoperative pain scores, age, body mass index, smoking habits, oral contraceptive pill use, infertility, and parity (adjusted odds ratio 2.96, 95% confidence interval 1.99-4.39; P<.001). The number of previous surgeries for endometriosis correlated significantly with lesion severity. Among women presenting with deeply infiltrating endometriosis (n=452), surgical history was significantly associated with a higher mean number of deeply infiltrating endometriosis lesions (3.1 ± 1.9 compared with 2.6 ± 1.8; P=.001) and with increased severity of deeply infiltrating endometriosis lesions, especially in the case of intestinal lesions (159 patients [66.0%] compared with 77 patients [37%], P<.001). CONCLUSION A history of surgery for endometriosis correlates with the presence and severity of deeply infiltrating endometriosis, which underlines the necessity of a thorough preoperative assessment and a complete information of these patients before undertaking subsequent surgeries. LEVEL OF EVIDENCE : II.
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Urinary endometriosis: MR imaging appearance with surgical and histological correlations. Diagn Interv Imaging 2014; 96:373-81. [PMID: 25556292 DOI: 10.1016/j.diii.2014.11.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The goals of the study were to describe the MR imaging features of endometriosis of the urinary tract and identify those that suggest intrinsic involvement of ureteric wall. MATERIALS AND METHODS Thirty-five women with proven urinary tract endometriosis and who had preoperative MR imaging between 2001 and 2011 were included retrospectively. MR images were intrepreted by one junior and one senior radiologists. To characterize the intrinsic parietal involvement, the ureteric circumference involved by the lesion of endometriosis was noted. RESULTS Thirty-eight ureteric and 13 bladder lesions were analyzed. They were found in association in nine women. Ureteric lesions were bilateral in seven women. Of the 38 ureteric lesions, 27 were extrinsic and 11 intrinsic at histopathological analysis. Sixteen women with extrinsic lesions and 10 with intrinsic ones were correctly identified on MR imaging. When the ureter was included less than 360° in the lesion, extrinsic involvement was confirmed in 80% of cases. CONCLUSION MR imaging appears to be more sensitive (91%vs 82%) but less specific (59% vs 67%) than surgery for the diagnosis of intrinsic form of ureteric location.
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Kang YJ, Jeung IC, Park A, Park YJ, Jung H, Kim TD, Lee HG, Choi I, Yoon SR. An increased level of IL-6 suppresses NK cell activity in peritoneal fluid of patients with endometriosis via regulation of SHP-2 expression. Hum Reprod 2014; 29:2176-89. [PMID: 25035432 DOI: 10.1093/humrep/deu172] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
STUDY QUESTION Is the decreased natural killer (NK) cell cytolytic activity in the peritoneal fluid (PF) of endometriosis patients due to primary cytokine activity? SUMMARY ANSWER An increased level of interleukin-6 (IL-6) in the PF of patients with endometriosis suppresses NK cell cytolytic activity by down-regulating cytolytic granule components, such as granzyme B and perforin, through the modulation of Src homology region 2-containing protein tyrosine phosphatase-2 (SHP-2) expression. WHAT IS ALREADY KNOWN Endometriosis is known to be related to a defect in NK cell cytolytic activity. Additionally, the levels of inflammatory cytokines are elevated in the PF of women with endometriosis. STUDY DESIGN, SIZE, DURATION The effects of PF on the differentiation and functional activity of NK cells were investigated in patients with or without endometriosis, and cytokines that reduce NK cell cytolytic activity in endometriosis patients were examined. The study included women who underwent laparoscopic examination for the diagnosis of endometriosis from August 2012 to July 2013 (33 women with, and 15 women without, endometriosis). PARTICIPANTS/MATERIALS, SETTING, METHODS Women of reproductive age (20-40 years old) who underwent laparoscopic examination for endometriosis were included. Cytokines present in the PF were identified by enzyme-linked immunosorbent assay. The cytolytic activity of NK cells in the PF was also analyzed using a calcein-acetoxy methyl ester (AM) release assay. MAIN RESULTS AND THE ROLE OF CHANCE PF from patients with endometriosis suppressed the differentiation and cytotoxicity of NK cells compared with PF from controls (P < 0.05). Increased levels of IL-6 were also found in the PF of patients with endometriosis (P < 0.01), and IL-6 levels were negatively correlated with the cytolytic activity of NK cells (rs = -0.558, P = 0.03). Furthermore, IL-6 reduced the cytolytic activity of NK cells, concomitantly with the down-regulation of granzyme B and perforin (P < 0.05), by modulating SHP-2. Importantly, the addition of anti-IL-6 to the PF of endometriosis patients restored the activity of NK cells (P < 0.01), suggesting that IL-6 plays a crucial role in the reduction of NK cell activity in the PF of patients with endometriosis. LIMITATIONS, REASONS FOR CAUTION PF contains various inflammatory cytokines in addition to IL-6 and so it is possible that other cytokines may affect the differentiation and activity of NK cells. WIDER IMPLICATIONS OF THE FINDINGS Our results imply that the suppression of IL-6 using an anti-IL-6 antibody or soluble IL-6 receptor could rescue the impairment of NK cell activity in patients with endometriosis. STUDY FUNDING/COMPETING INTERESTS This work was supported by the KRIBB Creative Research Program (KCS3051312); the STP project (DTM0111221) of the Ministry of Knowledge & Economy and the Basic Science Research Program (RBM0271312) of the National Research Foundation of Korea (NRF) from the Ministry of Education, Science & Technology. There are no conflicts of interest.
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Affiliation(s)
- Young-Ju Kang
- Immunotherapy Research Center, Korea Research Institute of Bioscience and Biotechnology, Yuseong-gu, Daejeon 305-806, Republic of Korea
| | - In Cheul Jeung
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Jung-gu, Daejeon 301-723, Republic of Korea
| | - Arum Park
- Immunotherapy Research Center, Korea Research Institute of Bioscience and Biotechnology, Yuseong-gu, Daejeon 305-806, Republic of Korea Department of Functional Genomics, University of Science & Technology, Yuseong-gu, Daejeon 305-350, Republic of Korea
| | - Young-Jun Park
- Immunotherapy Research Center, Korea Research Institute of Bioscience and Biotechnology, Yuseong-gu, Daejeon 305-806, Republic of Korea Department of Functional Genomics, University of Science & Technology, Yuseong-gu, Daejeon 305-350, Republic of Korea
| | - Haiyoung Jung
- Immunotherapy Research Center, Korea Research Institute of Bioscience and Biotechnology, Yuseong-gu, Daejeon 305-806, Republic of Korea Department of Functional Genomics, University of Science & Technology, Yuseong-gu, Daejeon 305-350, Republic of Korea
| | - Tae-Don Kim
- Immunotherapy Research Center, Korea Research Institute of Bioscience and Biotechnology, Yuseong-gu, Daejeon 305-806, Republic of Korea Department of Functional Genomics, University of Science & Technology, Yuseong-gu, Daejeon 305-350, Republic of Korea
| | - Hee Gu Lee
- Medical Genomics Research Center, Korea Research Institute of Bioscience and Biotechnology, Yuseong-gu, Daejeon 305-806, Republic of Korea
| | - Inpyo Choi
- Immunotherapy Research Center, Korea Research Institute of Bioscience and Biotechnology, Yuseong-gu, Daejeon 305-806, Republic of Korea Department of Functional Genomics, University of Science & Technology, Yuseong-gu, Daejeon 305-350, Republic of Korea
| | - Suk Ran Yoon
- Immunotherapy Research Center, Korea Research Institute of Bioscience and Biotechnology, Yuseong-gu, Daejeon 305-806, Republic of Korea Department of Functional Genomics, University of Science & Technology, Yuseong-gu, Daejeon 305-350, Republic of Korea
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Abstract
Endometriosis is defined as the presence of endometrial-type mucosa outside the uterine cavity. Of the proposed pathogenic theories (retrograde menstruation, coelomic metaplasia and Müllerian remnants), none explain all the different types of endometriosis. According to the most convincing model, the retrograde menstruation hypothesis, endometrial fragments reaching the pelvis via transtubal retrograde flow, implant onto the peritoneum and abdominal organs, proliferate and cause chronic inflammation with formation of adhesions. The number and amount of menstrual flows together with genetic and environmental factors determines the degree of phenotypic expression of the disease. Endometriosis is estrogen-dependent, manifests during reproductive years and is associated with pain and infertility. Dysmenorrhoea, deep dyspareunia, dyschezia and dysuria are the most frequently reported symptoms. Standard diagnosis is carried out by direct visualization and histologic examination of lesions. Pain can be treated by excising peritoneal implants, deep nodules and ovarian cysts, or inducing lesion suppression by abolishing ovulation and menstruation through hormonal manipulation with progestins, oral contraceptives and gonadotropin-releasing hormone agonists. Medical therapy is symptomatic, not cytoreductive; surgery is associated with high recurrence rates. Although lesion eradication is considered a fertility-enhancing procedure, the benefit on reproductive performance is moderate. Assisted reproductive technologies constitute a valid alternative. Endometriosis is associated with a 50% increase in the risk of epithelial ovarian cancer, but preventive interventions are feasible.
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Affiliation(s)
- Paolo Vercellini
- Department of Obstetrics and Gynecology, Fondazione Cà Granda, Ospedale Maggiore Policlinico, Via Commenda 12, 20122 Milan, Italy
| | - Paola Viganò
- Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, San Raffaele Scientific Institute, Via Olgettina 60, 20136 Milan, Italy
| | - Edgardo Somigliana
- Department of Obstetrics and Gynecology, Fondazione Cà Granda, Ospedale Maggiore Policlinico, Via Commenda 12, 20122 Milan, Italy
| | - Luigi Fedele
- Department of Obstetrics and Gynecology, Fondazione Cà Granda, Ospedale Maggiore Policlinico, Via Commenda 12, 20122 Milan, Italy
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Dyson MT, Roqueiro D, Monsivais D, Ercan CM, Pavone ME, Brooks DC, Kakinuma T, Ono M, Jafari N, Dai Y, Bulun SE. Genome-wide DNA methylation analysis predicts an epigenetic switch for GATA factor expression in endometriosis. PLoS Genet 2014; 10:e1004158. [PMID: 24603652 PMCID: PMC3945170 DOI: 10.1371/journal.pgen.1004158] [Citation(s) in RCA: 128] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 12/18/2013] [Indexed: 11/19/2022] Open
Abstract
Endometriosis is a gynecological disease defined by the extrauterine growth of endometrial-like cells that cause chronic pain and infertility. The disease is limited to primates that exhibit spontaneous decidualization, and diseased cells are characterized by significant defects in the steroid-dependent genetic pathways that typify this process. Altered DNA methylation may underlie these defects, but few regions with differential methylation have been implicated in the disease. We mapped genome-wide differences in DNA methylation between healthy human endometrial and endometriotic stromal cells and correlated this with gene expression using an interaction analysis strategy. We identified 42,248 differentially methylated CpGs in endometriosis compared to healthy cells. These extensive differences were not unidirectional, but were focused intragenically and at sites distal to classic CpG islands where methylation status was typically negatively correlated with gene expression. Significant differences in methylation were mapped to 403 genes, which included a disproportionally large number of transcription factors. Furthermore, many of these genes are implicated in the pathology of endometriosis and decidualization. Our results tremendously improve the scope and resolution of differential methylation affecting the HOX gene clusters, nuclear receptor genes, and intriguingly the GATA family of transcription factors. Functional analysis of the GATA family revealed that GATA2 regulates key genes necessary for the hormone-driven differentiation of healthy stromal cells, but is hypermethylated and repressed in endometriotic cells. GATA6, which is hypomethylated and abundant in endometriotic cells, potently blocked hormone sensitivity, repressed GATA2, and induced markers of endometriosis when expressed in healthy endometrial cells. The unique epigenetic fingerprint in endometriosis suggests DNA methylation is an integral component of the disease, and identifies a novel role for the GATA family as key regulators of uterine physiology-aberrant DNA methylation in endometriotic cells correlates with a shift in GATA isoform expression that facilitates progesterone resistance and disease progression.
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Affiliation(s)
- Matthew T. Dyson
- Division of Reproductive Biology Research, Dept. Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Damian Roqueiro
- Laboratory of Computational Functional Genomics, Dept. Bioengineering, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Diana Monsivais
- Division of Reproductive Biology Research, Dept. Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - C. Mutlu Ercan
- Division of Reproductive Biology Research, Dept. Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Mary Ellen Pavone
- Division of Reproductive Biology Research, Dept. Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - David C. Brooks
- Division of Reproductive Biology Research, Dept. Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Toshiyuki Kakinuma
- Division of Reproductive Biology Research, Dept. Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Masanori Ono
- Division of Reproductive Biology Research, Dept. Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Nadereh Jafari
- Division of Reproductive Biology Research, Dept. Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Yang Dai
- Laboratory of Computational Functional Genomics, Dept. Bioengineering, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Serdar E. Bulun
- Division of Reproductive Biology Research, Dept. Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
- * E-mail:
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Lee DY, Kim HJ, Yoon BK, Choi D. Factors associated with the laterality of recurrent endometriomas after conservative surgery. Gynecol Endocrinol 2013; 29:978-81. [PMID: 24004294 DOI: 10.3109/09513590.2013.824959] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We evaluated the laterality of primary endometrioma and characteristics of patients according to the laterality of recurrent endometrioma in 140 women with recurrent endometrioma after conservative surgery. Histologically confirmed recurrent endometriomas were found on the left side in 49 patients (35.0%), the right in 44 (31.4%) and bilaterally in 47 (33.6%). The sites of primary endometrioma were not associated with those of recurrent endometrioma, and the recurrence rate in the treated ovary (59.8%) was similar to that of the intact ovary (69.0%) at the primary surgery. Proportions of stage IV endometriosis and posterior cul-de-sac obliteration were higher in patients with bilateral recurrence than in those with unilateral recurrence (p < 0.01 for all comparisons) and in patients with contralateral recurrence than in those with ipsilateral recurrence (p < 0.05 for all comparisons), but no differences were found in other characteristics of participants according to the laterality or pattern of recurrence. In conclusion, the lateral distribution of recurrent endometrioma was not associated with that of the primary lesion, and endometrioma did not recur more frequently in the treated ovary. An advanced stage and the presence of posterior cul-de-sac obliteration were factors associated with bilateral or contralateral recurrence of endometrioma.
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Affiliation(s)
- Dong-Yun Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Korea
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Borghese B, Santulli P, Vaiman D, Alexandre J, Goldwasser F, Chapron C. Les cancers de l’ovaire associés à l’endométriose : physiopathologie et conséquences sur la pratique clinique. ACTA ACUST UNITED AC 2013; 42:325-33. [DOI: 10.1016/j.jgyn.2013.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 02/19/2013] [Accepted: 02/28/2013] [Indexed: 01/07/2023]
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Zhang ZZ, Hu CP, Tang WW, Gui T, Qian RY, Xing YX, Cao P, Wan GP. Wenshen Xiaozheng Tang suppresses the growth of endometriosis with an antiangiogenic effect. Climacteric 2013; 16:700-8. [DOI: 10.3109/13697137.2013.771331] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Pelzer ES, Allan JA, Waterhouse MA, Ross T, Beagley KW, Knox CL. Microorganisms within human follicular fluid: effects on IVF. PLoS One 2013; 8:e59062. [PMID: 23554970 PMCID: PMC3595219 DOI: 10.1371/journal.pone.0059062] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 02/11/2013] [Indexed: 11/22/2022] Open
Abstract
Our previous study reported microorganisms in human follicular fluid. The objective of this study was to test human follicular fluid for the presence of microorganisms and to correlate these findings with the in vitro fertilization (IVF) outcomes. In this study, 263 paired follicular fluids and vaginal swabs were collected from women undergoing IVF cycles, with various causes for infertility, and were cultured to detect microorganisms. The cause of infertility and the IVF outcomes for each woman were correlated with the microorganisms detected within follicular fluid collected at the time of trans-vaginal oocyte retrieval. Microorganisms isolated from follicular fluids were classified as: (1) ‘colonizers’ if microorganisms were detected within the follicular fluid, but not within the vaginal swab (at the time of oocyte retrieval); or (2) ‘contaminants’ if microorganisms detected in the vagina at the time of oocyte retrieval were also detected within the follicular fluid. The presence of Lactobacillus spp. in ovarian follicular fluids was associated with embryo maturation and transfer. This study revealed microorganisms in follicular fluid itself and that the presence of particular microorganisms has an adverse affect on IVF outcomes as seen by an overall decrease in embryo transfer rates and pregnancy rates in both fertile and infertile women, and live birth rates in women with idiopathic infertility. Follicular fluid microorganisms are a potential cause of adverse pregnancy outcomes in IVF in both infertile women and in fertile women with infertile male partners.
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Affiliation(s)
- Elise S Pelzer
- Institute of Health and Biomedical Innovation, Faculty of Science and Technology, Queensland University of Technology, Brisbane, Queensland, Australia.
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Affiliation(s)
- Ov D Slayden
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Sciences University, Beaverton, OR 97006, USA.
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[Recurrence of pain after surgery for deeply infiltrating endometriosis: How does it happen? How to manage?]. ACTA ACUST UNITED AC 2012; 43:12-8. [PMID: 23265672 DOI: 10.1016/j.jgyn.2012.11.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 11/02/2012] [Accepted: 11/12/2012] [Indexed: 12/13/2022]
Abstract
Recurrence of deep endometriosis remains a major issue in the management of endometriosis. The main cause for recurrence appears to be an incomplete excisional surgery. Therefore, the goal of the primary surgery should be the complete resection of all endometriotic lesions. If surgical skills cannot meet this objective it seems preferable to refer the patient to a center with a recognized expertise in this field rather than performing an incomplete surgery. It seems also possible to tailor the indications according to the symptoms, especially when endometriosis affects the bladder in association with an asymptomatic vaginal and/or rectal involvement. This strategy does not increase the rate of recurrence. Postoperative medical treatment based on ovarian function suppression is attractive as it diminishes the recurrence rate. Facing the recurrence, appropriate assessment of the benefit risk balance must be performed. Medical treatment is an option. When surgery is chosen, it seems interesting to discuss carefully the indication of hysterectomy with bilateral oophorectomy, especially for women over 40 years old with no desire for pregnancy and/or symptomatic adenomyosis. Risks of induced ovarian castration must be taken into account.
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Streuli I, de Ziegler D, Borghese B, Santulli P, Batteux F, Chapron C. New treatment strategies and emerging drugs in endometriosis. Expert Opin Emerg Drugs 2012; 17:83-104. [PMID: 22439891 DOI: 10.1517/14728214.2012.668885] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Introduction: Endometriosis, histologically defined as the presence of endometrium-like tissue - glands and stroma - that develops outside of the uterine cavity, is still an enigmatic disease responsible for pelvic pain and infertility. The current treatments of endometriosis are surgery and hormonal therapies that act by suppressing ovulation and/or directly on steroid receptors located in endometriotic lesions. Areas covered: New hormonal and non-hormonal therapies are being developed for the treatment of endometriosis-related pain. The authors review the state of advancement and the results of novel treatments studied in registered trials ( www.ClinicalTrials.gov ). Cellular signaling pathways activated in endometriotic cells, which constitute potential targets for future treatments, are also described. Expert opinion: Therapeutic research efforts should focus on identifying and testing substances capable of acting locally on the lesions themselves, without interfering with ovulation, in order to be efficacious on both pain symptoms and infertility.
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Affiliation(s)
- Isabelle Streuli
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine - Assistance Publique des Hôpitaux de Paris, CHU Cochin, Department of Obstetrics Gynaecology and Reproductive Medicine , Paris , France
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