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Malik R, Mann MK. Role of Dienogest in Endometriosis in Young Women. J Obstet Gynaecol India 2021; 71:522-529. [PMID: 34602764 DOI: 10.1007/s13224-021-01483-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 04/13/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction Endometriosis associated pelvic pain (EAPP) is the most common complaint of patients with endometriosis. Nearly, 70% of females with endometriosis present with EAPP while endometriomas are found in 17-44% of patients. Material and Methods A short-term single centre study was carried out in 56 patients in the age group of 15-35 years with complaints of pain and diagnosed as endometriosis either by imaging studies and/or by laparoscopy was given dienogest 2 mg OD, and effect of treatment was seen as improvement of pain score over a period of 3 months. The effect of dienogest was also seen on size of endometrioma. Patients were followed up at 1 and 3 months. Results and Discussion Out of 56 patients, 38 (67.8%) patients reported their pain relief within 2-5 days after starting dienogest. Out of 41 patients (73%) who had severe pain at enrollment, only 1 patient (1.79%) complained of severe pain at the end of 1 month with dienogest. Successful reduction in endometriotic cyst size (>50%) was seen in 3 patients (5.3%) at the end of 1 month with dienogest. Out of 56 patients, 41 patients (73.2%) had significant pain relief (>30%) at three months of treatment. At the end of 3 months, seven patients (12.5%) had significant cyst size reduction (>50%) with dienogest. No major side effects were noted. Conclusion Dienogest is well tolerated drug for endometriosis showing significant relief of pain. However, it was seen that though endometriomas did not grow during treatment, significant regression was uncommon.
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Affiliation(s)
- Renuka Malik
- Department of OB-GYN, ABVIMS & DR RML Hospital, Delhi, India
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Estudio piloto sobre el efecto de la vitamina D en la patogenia de los miomas uterinos: influencia de la terapia con vitamina D en el volumen uterino y en la angiogénesis de los miomas determinados por ECO3DPW y niveles séricos de VEGF. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2020. [DOI: 10.1016/j.gine.2020.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Angioni S, Pontis A, Malune ME, Cela V, Luisi S, Litta P, Vignali M, Nappi L. Is dienogest the best medical treatment for ovarian endometriomas? Results of a multicentric case control study. Gynecol Endocrinol 2020; 36:84-86. [PMID: 31311360 DOI: 10.1080/09513590.2019.1640674] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Ovarian endometriomas are common manifestations of endometriosis. Surgical excision has been shown to potentially decrease ovarian reserves. In this prospective study, we included 81 patients with ovarian endometriosis. 40 were treated with 2 mg of dienogest daily (DNG) and 41 were treated with cyclic oral estro-progestins (ethinyl estradiol 30 mcg [EE] plus dienogest 2 mg) (DNG + EE). Aim of the study was the effect of the treatment on the size of the endometriotic cysts. Further, in the symptomatic patients, follow-up included an evaluation of chronic pain before and during treatment. Both treatments were able to significantly decrease the pain in symptomatic patients with no statistical differences. The mean visual analog scale score at enrollment was 65 ± 14 and 70 ± 18, and there was significant improvement (19 ± 15, p < .001, DNG; 18 ± 12, p < .001, DNG + EE). The size of the endometrioma cysts were significantly reduced in the DNG group. The mean cyst diameter was 52 ± 22 mm at baseline and 32 ± 12 mm after six months of treatment (p < .001), yielding a 75% volume reduction in DNG group. The decrease in the size of endometrioma cysts observed in the women treated with only progestin could be noteworthy, as it may reduce the negative impacts on the affected ovary and avoid surgery.
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Affiliation(s)
- Stefano Angioni
- Department of Obstetrics and Gynecology, Azienda Ospedaliero Universitaria, Presidio Policlinico di Monserrato, University of Cagliari, Monserrato, Italy
| | - Alessandro Pontis
- Department of Obstetrics and Gynecology, San Francesco Hospital, Nuoro, Italy
| | - Maria E Malune
- Department of Obstetrics and Gynecology, Azienda Ospedaliero Universitaria, Presidio Policlinico di Monserrato, University of Cagliari, Monserrato, Italy
| | - Vito Cela
- Department of Obstetrics and Gynecology, University of Pisa, Pisa, Italy
| | - Stefano Luisi
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Pietro Litta
- Department of Gynaecological Sciences and Human Reproduction, University of Padua, Padua, Italy
| | | | - Luigi Nappi
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, Foggia, Italy
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Rizzello F, Capezzuoli T, D'Amato Scherbatoff I, Cozzolino M, Gandini L, Coccia ME. Three-Dimensional Power Doppler Vascularization in Women With Ovarian Endometriomas and Relationship With Associated Painful Symptoms. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:2271-2278. [PMID: 28556312 DOI: 10.1002/jum.14258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 02/09/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The objective of the study was to evaluate the correlation between endometrioma-associated pain and lesion vascularization as measured with 3-dimensional power Doppler transvaginal sonography. METHODS Endometriomas were examined, and 4 indices were obtained: mean grayness, flow index, vascularization index, and vascularization-flow index. Dysmenorrhea, chronic pelvic pain, and dyspareunia were analyzed in terms of severity, presence/absence, and duration. RESULTS Twenty-nine women were selected. The univariable association of painful symptoms in terms of presence/absence and duration was low with the exception of mean grayness with the presence of chronic pelvic pain (β = -0.106; P = .047; 95% confidence interval, 0.810 to 0.998). The R2 value increased to 0.226 for dysmenorrhea (β = -0.475; P = .029) when analyzing the association between the vascularization index and the severity of painful symptoms. The visual analog scale scores for chronic pelvic pain and dyspareunia were higher (R2 = 0.300; β = -0.547 and -0.548, respectively; P = .028 and .053). CONCLUSIONS We observed an inverse association between the severity of pain and endometrioma vascularization. Further larger studies are required to confirm our findings.
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Affiliation(s)
- Francesca Rizzello
- Department of Clinical and Experimental Biomedical Sciences, University of Florence, Florence, Italy
| | - Tommaso Capezzuoli
- Department of Clinical and Experimental Biomedical Sciences, University of Florence, Florence, Italy
| | | | - Mauro Cozzolino
- Department of Clinical and Experimental Biomedical Sciences, University of Florence, Florence, Italy
| | - Loredana Gandini
- Department of Clinical and Experimental Biomedical Sciences, University of Florence, Florence, Italy
- Department of Experimental Medicine, Section of Medical Physiopathology, University of Rome La Sapienza, Rome, Italy
| | - Maria Elisabetta Coccia
- Department of Clinical and Experimental Biomedical Sciences, University of Florence, Florence, Italy
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Vinci G, Arkwright S, Audebourg A, Radenen B, Chapron C, Borghese B, Dousset B, Mehats C, Vaiman D, Vacher-Lavenu MC, Gogusev J. Correlation Between the Clinical Parameters and Tissue Phenotype in Patients Affected by Deep-Infiltrating Endometriosis. Reprod Sci 2016; 23:1258-68. [PMID: 26994067 DOI: 10.1177/1933719116638188] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The current study aimed to identify and validate an applicable immunohistochemistry panel including Ki-67, c-MYC, estrogen receptor-α (ER-α), and progesterone receptor isoforms A/B (PR-A/B) in correlation with clinicopathological parameters in patients affected by deep infiltrating endometriosis. Tissue microarrays were prepared from a cohort of 113 patients. Phenotypic profile of the panel molecules was evaluated in glands and stroma in parallel with microvessels and stroma density measurements. Principal component analysis was performed on 8 immunohistochemical variables, 2 histological variables, and 8 subgroups of clinical parameters. The immunohistochemical profiling showed consistent Ki-67 immunostaining in 17.9% of the samples and c-MYC in 83.1%, while intense ER-α immunoreactivity was detected in 84% of the samples and PR-A/B isoforms in 24.1% of them. The combination of clinical parameters and tissue phenotype allowed a stratification of endometriosis-affected patients. Such novel phenotypical and clinical correlation could be helpful in the future studies for a better stratification of the disease aiming at a personalized patient care.
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Affiliation(s)
- Giovanna Vinci
- Cochin Institute, Inserm U1016, CNRS 8104, Université Paris Descartes, Paris, France
| | - Sylviane Arkwright
- Department of Pathology, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Cochin Hospital, Paris, France
| | - Anne Audebourg
- Department of Pathology, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Cochin Hospital, Paris, France
| | - Brigitte Radenen
- Department of Pathology, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Cochin Hospital, Paris, France
| | - Charles Chapron
- Department of Gynecology Obstetrics II and Reproductive Medicine, Faculté de Médecine, AP-HP, Groupe Hospitalier Ouest, Centre Hospitalier Universitaire Paris Centre, Paris, France
| | - Bruno Borghese
- Department of Gynecology Obstetrics II and Reproductive Medicine, Faculté de Médecine, AP-HP, Groupe Hospitalier Ouest, Centre Hospitalier Universitaire Paris Centre, Paris, France
| | - Bertrand Dousset
- Service de Chirurgie Digestive Hépatobiliaire et Endocrinienne Faculté de Médecine, AP-HP, Groupe Hospitalier Ouest, Centre Hospitalier Universitaire Paris Centre, Paris, France
| | - Celine Mehats
- Cochin Institute, Inserm U1016, CNRS 8104, Université Paris Descartes, Paris, France
| | - Daniel Vaiman
- Cochin Institute, Inserm U1016, CNRS 8104, Université Paris Descartes, Paris, France
| | - Marie-Cécile Vacher-Lavenu
- Department of Pathology, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Cochin Hospital, Paris, France
| | - Jean Gogusev
- Cochin Institute, Inserm U1016, CNRS 8104, Université Paris Descartes, Paris, France
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An Update on Surgical versus Expectant Management of Ovarian Endometriomas in Infertile Women. BIOMED RESEARCH INTERNATIONAL 2015; 2015:204792. [PMID: 26240817 PMCID: PMC4512511 DOI: 10.1155/2015/204792] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 01/13/2015] [Accepted: 01/13/2015] [Indexed: 11/30/2022]
Abstract
Ovarian endometriomas are a common manifestation of endometriosis that can represent a more severe stage of the disease. There is much debate over the treatment of these cysts in infertile women, particularly before use of assisted reproductive technologies. Evidence exists that supports surgical excision of ovarian endometriomas, as well as evidence that cautions against surgical intervention. Certain factors need to be examined closely before proceeding with surgery or continuing with expectant management. These include the patient's symptoms, age, ovarian reserve, size and laterality of the cyst, prior surgical treatment, and level of suspicion for malignancy. The most recent evidence appears to suggest that certain patient profiles may benefit from proceeding directly to in vitro fertilization (IVF). These include symptomatic infertile patients, especially those that are older, those that have diminished ovarian reserve, those that have bilateral endometriomas, or those that have had prior surgical treatment. Although endometriomas can be detrimental to the ovarian reserve, surgical therapy may further lower a woman's ovarian reserve. Nevertheless, the presence of an endometrioma does not appear to adversely affect IVF outcomes, and surgical excision of endometriomas does not appear to improve IVF outcomes. Regardless of treatment plan, infertile patients with endometriomas must be counseled appropriately before choosing either treatment path.
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Orief YI, Karkor TAE, Aly Saleh H, El Hadidy AS, Badr N. Comparative evaluation of vascular endothelial growth factor-A expression in pre-ovulatory follicular fluid in normogonadotrophic and endometriotic patients undergoing assisted reproductive techniques. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2014. [DOI: 10.1016/j.mefs.2013.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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Virani S, Edwards AK, Thomas R, Childs T, Tayade C. Blocking of stromal cell-derived factor-1 reduces neoangiogenesis in human endometriosis lesions in a mouse model. Am J Reprod Immunol 2013; 70:386-97. [PMID: 23650939 DOI: 10.1111/aji.12134] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 04/03/2013] [Indexed: 02/03/2023] Open
Abstract
PROBLEM Endometriosis affects 5-10% of women and is characterized by the growth of endometrial tissue outside of the uterus. Establishing new blood supply is a fundamental requirement for endometriosis lesion growth. Endothelial progenitor cells (EPCs), recruited by stromal cell-derived factor-1 (SDF-1), contribute to neoangiogenesis in endometriotic lesions. We hypothesized that SDF-1 is central to the neoangiogenesis and survival of endometriotic lesions, and blocking of SDF-1 will reduce vascularization of lesions in a mouse model. METHOD OF STUDY Using immunohistochemistry, we evaluated SDF-1 and CD34(+) EPCs in human endometriotic lesions and normal endometrium samples. EPCs were co-localized using CD34 and VEGFR2. Effects of SDF-1 blocking on endometriotic lesion survival were assessed in BALB/c-Rag2(-/-) /IL2rγ(-/-) mice engrafted with human endometrium and treated with SDF-1-blocking antibody or an isotype control. Weekly blood samples from experimental mice were analyzed for cytokines and EPCs. RESULTS SDF-1 and CD34(+) EPCs were abundant in human endometriotic lesions compared with eutopic endometrium. In our mouse model, SDF-1-blocking antibody reduced CD31(+) microvessels compared with isotype control. CONCLUSION Blocking SDF-1 reduces neovascularization and survival of lesions in a mouse model of endometriosis.
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Affiliation(s)
- Sophia Virani
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
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Seckin B, Oruc AS, Turkcapar F, Ugur M. The relation of pelvic pain and dense adhesions to Doppler ultrasound findings in patients with ovarian endometriomas. Arch Gynecol Obstet 2012. [PMID: 23179800 DOI: 10.1007/s00404-012-2630-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To study the relation of pelvic pain symptoms and pelvic adhesions to Doppler ultrasound findings in patients with ovarian endometriomas. METHODS 62 patients who underwent laparoscopic surgery for endometrioma were divided into two groups according to their pelvic pain symptoms. Group 1 (n = 27) included patients with pelvic pain, group 2 (n = 35) asymptomatic patients. Patients were evaluated for the vascularization of endometrioma by transvaginal color and power Doppler ultrasonography before the surgery. The presence and amount of blood flow reported in terms of a color scale, pulsed Doppler indices, and dense pelvic adhesions were compared between the groups. The relation of Doppler ultrasound findings to the dense pelvic adhesions was also analyzed. RESULTS Blood flow was present in 74.1 % (n = 20) of patients in group 1 and 68.6 % (n = 24) in group 2 (p = 0.63). The volume and vascularization of the endometriomas, pulsed Doppler indices, stage of endometriosis, and the presence of dense pelvic adhesions were also similar. Patients with dense pelvic adhesions had significantly higher amount of blood flow compared to patients without adhesions (p = 0.006), but the mean pulsatility index and resistance index were not different between the groups (p = 0.55 and 0.59, respectively). CONCLUSIONS Pelvic pain symptoms were not found to be related to endometrioma vascularization. On the other hand, we observed an association between higher vascularized endometrioma and the presence of dense pelvic adhesions.
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Affiliation(s)
- Berna Seckin
- Department of Reproductive Endocrinology and Endoscopic Surgery, Zekai Tahir Burak Women's Health Research and Education Hospital, Ankara, Turkey.
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QIU JUNJUN, LIU MANHUA, ZHANG ZHONGXIN, CHEN LIPING, YANG QICHANG, LIU HONGBING. Transvaginal color Doppler sonography predicts ovarian interstitial fibrosis and microvascular injury in women with ovarian endometriotic cysts. Acta Obstet Gynecol Scand 2012; 91:605-12. [DOI: 10.1111/j.1600-0412.2012.01370.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Haoula Z, Deshpande R, Jayaprakasan K, Raine-Fenning N. Doppler imaging in the diagnosis of ovarian disease. EXPERT OPINION ON MEDICAL DIAGNOSTICS 2012; 6:59-73. [PMID: 23480621 DOI: 10.1517/17530059.2012.642366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Pelvic ultrasonography remains the non-invasive imaging modality of choice for detecting and characterising adnexal masses. The use of Doppler ultrasound has improved the differential diagnosis of ovarian disease and helped to widen the understanding of the aetiology and possible pathophysiology of the various underlying conditions with an aim of improved diagnosis and management. AREAS COVERED This review describes the basis of different Doppler techniques and their application in ovarian disease. The present evidence is critically analysed in an attempt to define the current role of Doppler ultrasound of the ovaries. The technique holds promise in certain ovarian diseases but remains controversial in others. EXPERT OPINION Doppler ultrasound has a role in both the clinical and research settings. Clinically, it can be used to differentiate benign and malignant disease and help confirm diagnoses suggested on grey-scale imaging giving the user more confidence. Its use here, however, is generally restricted to a subjective impression of colour flow rather than a quantitative analysis of vascularity or blood flow velocity. These measures are more relevant in the research setting where quantitative Doppler is being used to clarify the possible underlying aetiology of various ovarian diseases such as polycystic ovarian syndrome and benign cysts. Doppler ultrasound has also been used in various models to evaluate the response to ovarian stimulation and the effect of surgery on the ovary.
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Affiliation(s)
- Zeina Haoula
- University of Nottingham, School of Clinical Sciences, Division of Obstetrics & Gynaecology , Nottingham , UK +44 0 115 823 1000 ; +44 0 115 823 0704 ;
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Qiu JJ, Liu YL, Liu MH, Chen LP, Xu DW, Zhang ZX, Yang QC, Liu HB. Ovarian interstitial blood flow changes assessed by transvaginal colour Doppler sonography: predicting ovarian endometrioid cyst-induced injury to ovarian interstitial vessels. Arch Gynecol Obstet 2011; 285:427-33. [DOI: 10.1007/s00404-011-1971-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2010] [Accepted: 06/23/2011] [Indexed: 10/18/2022]
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Alcázar JL, Guerriero S, Laparte C, Ajossa S, Jurado M. Contribution of power Doppler blood flow mapping to gray-scale ultrasound for predicting malignancy of adnexal masses in symptomatic and asymptomatic women. Eur J Obstet Gynecol Reprod Biol 2011; 155:99-105. [PMID: 21211896 DOI: 10.1016/j.ejogrb.2010.11.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Revised: 10/18/2010] [Accepted: 11/22/2010] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the contribution of power Doppler blood flow mapping to gray-scale ultrasound for predicting malignancy of adnexal masses in symptomatic and asymptomatic women. STUDY DESIGN One thousand and ninety-four women with adnexal mass were included. Patients were divided into three groups according to clinical complaints: asymptomatic (group A), patients with symptoms non-suspicious of ovarian cancer (group B) and patients with symptoms suspicious of ovarian cancer (group C). All patients underwent transvaginal power Doppler ultrasound prior to surgery. Any mass in which the echo architecture at B-mode ultrasound was not highly suggestive of benign histology was categorized as questionable. In these cases power Doppler was performed as the second step. Definitive histological diagnosis was used as the standard reference. Sensitivity, specificity, positive likelihood ratio (+LR) and negative likelihood ratio (-LR) were calculated for B-mode diagnosis and B-mode plus Doppler in each group. RESULTS In group A, B-mode was significantly more sensitive (98.1%) than Doppler ultrasound (91.3%) (p<0.01). In group B Doppler ultrasound (97.0%) was more specific than B-mode ultrasound (92.2%) (p<0.001). In group C Doppler ultrasound (84.0%) was more specific than B-mode ultrasound (68.0%) (p<0.001). Positive LR was significantly higher after Doppler evaluation in all groups (30.5 vs 12.8 in group A, 33.2 vs 12.8 in group B and 6.0 vs 3.1 in group C). CONCLUSIONS The diagnostic performance of B-mode and power Doppler ultrasound is different depending on patients' complaints.
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Affiliation(s)
- Juan Luis Alcázar
- Department of Obstetrics and Gynecology, Clinica Universitaria de Navarra, University of Navarra, Pamplona, Spain.
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Borghese B, Vaiman D, Mondon F, Mbaye M, Anaf V, Noël JC, de Ziegler D, Chapron C. Neurotrophines et douleur : étude d’expression et de corrélation dans l’endométriose. ACTA ACUST UNITED AC 2010; 38:442-6. [DOI: 10.1016/j.gyobfe.2010.05.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Accepted: 03/03/2010] [Indexed: 01/10/2023]
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Taylor RN, Yu J, Torres PB, Schickedanz AC, Park JK, Mueller MD, Sidell N. Mechanistic and therapeutic implications of angiogenesis in endometriosis. Reprod Sci 2009; 16:140-6. [PMID: 19001553 PMCID: PMC2852133 DOI: 10.1177/1933719108324893] [Citation(s) in RCA: 143] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Like tumor metastases, endometriotic implants require neovascularization to proliferate and invade into ectopic sites within the host. Endometrial tissue, with its robust stem cell populations and remarkable regenerative capabilities, is a rich source of proangiogenic factors. Among the most potent and extensively studied of these proteins, vascular endothelial growth factor has emerged as a critical vasculogenic regulator in endometriosis. Accordingly, angiogenesis of the nascent endometriotic lesion has become an attractive target for novel medical therapeutics and strategies to inhibit vascular endothelial growth factor action. Vascular endothelial growth factor gene regulation in endometrial and endometriosis cells by nuclear receptors, other transcription factors, and also by infiltrating immune cells is emphasized. New data showing that oxidative and endoplasmic reticulum stress increase vascular endothelial growth factor expression are provided. Finally, we review the clinical implications of angiogenesis in this condition and propose potential antiangiogenic therapies that may become useful in the control or eradication of endometriotic lesions.
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Affiliation(s)
- Robert N Taylor
- Department of Gynecology and Obstetrics, Human Uterine Biology Program, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
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García-Manero M, Santana GT, Alcázar JL. Relationship between Microvascular Density and Expression of Vascular Endothelial Growth Factor in Patients with Ovarian Endometriosis. J Womens Health (Larchmt) 2008; 17:777-82. [DOI: 10.1089/jwh.2007.0695] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Manuel García-Manero
- Department of Obstetrics and Gynecology, Clínica Universitaria de Navarra, University of Navarra, Pamplona, Spain
| | - Gemma Toledo Santana
- Department of Pathology, Clínica Universitaria de Navarra, University of Navarra, Pamplona, Spain
| | - Juan Luis Alcázar
- Department of Obstetrics and Gynecology, Clínica Universitaria de Navarra, University of Navarra, Pamplona, Spain
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Zhang G, Dmitrieva N, Liu Y, McGinty KA, Berkley KJ. Endometriosis as a neurovascular condition: estrous variations in innervation, vascularization, and growth factor content of ectopic endometrial cysts in the rat. Am J Physiol Regul Integr Comp Physiol 2008; 294:R162-71. [DOI: 10.1152/ajpregu.00649.2007] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Endometriosis is a poorly understood, estradiol-dependent condition associated with severe pelvic pains and defined by vascularized endometrial growths outside the uterus. Endometriosis is produced in cycling rats by autotransplanting pieces of uterus onto abdominal arteries where they develop into cysts. The surgery induces vaginal and abdominal muscle hyperalgesia, whose severity is greatest in proestrus and nearly absent in estrus. The cysts contain growth factors and cytokines and develop their own sympathetic and sensory C- and Aδ-fiber innervation. Here, we used quantitative immunostaining and protein array analyses to test the hypothesis that the innervation and growth factor/cytokine content of the cysts, but not uterine horn, contribute to proestrous-to-estrous changes in hyperalgesic severity. If so, these characteristics in the cysts, but not the uterine horn, should change with estrous stage. In cysts, the density of sympathetic (but not sensory) neurites and amounts of NGF and VEGF proteins (but not cytokines IL-1, IL-6, IL-10, or TNF-α) were greater in proestrus than estrus. These changes were accompanied by vascular changes. Both sympathetic and sensory fibers in both stages colabeled with TrkA, indicating that changes in NGF could act on both afferent and efferent fibers. In contrast with the cysts, no changes occurred in the uterine horn between proestrus and estrus. Together, these results suggest that coordinated proestrous-to-estrous changes in innervation and vascularization of the cysts contribute to similar changes in hyperalgesic severity. The findings also encourage consideration of endometriosis as a neurovascular condition.
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