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Wang Z, Cui F, Chen Y, Liu H, Zhang Y, Shi Y, Zhang Y, Wang Y, Liang N, Xu L, Liu Y, Liu Z, Shi W. Establishment of an immortalized cell line derived from human adenomyosis ectopic lesions. Tissue Cell 2024; 86:102284. [PMID: 38134573 DOI: 10.1016/j.tice.2023.102284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/24/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023]
Abstract
Because adenomyosis (AM) ectopic primary cells are hard to come by, have a short lifespan, and the characteristics that alter over time, their utility in AM research is constrained. This study aimed to establish a line of immortalized human adenomyosis ectopic cell (ihAMEC) to change this situation. Primary cells were obtained from AM ectopic lesion tissue and then infected with Simian Vacuolating Virus 40 Tag (SV40 T) lentivirus and screened to establish immortalized cells. We verified the main features and found that the ihAMEC could be cultured for more than 50 generations and the proliferation ability of ihAMEC was more active than that of primary cells. The cytoskeleton and cell types of ihAMEC were similar to primary cells and maintained a normal karyotype. The expression of epithelial-mesenchymal transition (EMT) markers, estrogen-metabolizing proteins, and estrogen/progesterone receptors in ihAMEC was similar to the expression seen in primary cells. In addition, the response of ihAMEC under estrogen treatment and Lipopolysaccharide intervention is similar to primary cells. The clonogenic ability of ihAMEC was lower than tumor cells and did not form tumors in tumorigenicity assays. Thus, ihAMEC can be used as in vitro cellular model for pathogenesis and drug development studies regarding AM.
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Affiliation(s)
- Zilu Wang
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250014, China
| | - Fengxin Cui
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250014, China
| | - Yinuo Chen
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250014, China
| | - Hongyun Liu
- Department of Gynecology, Linyi Central Hospital, Linyi, Shandong 276400, China
| | - Yiran Zhang
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250014, China
| | - Yaxin Shi
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250014, China
| | - Yinuo Zhang
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250014, China
| | - Yanfei Wang
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250014, China
| | - Na Liang
- The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong 250011, China.
| | - Li Xu
- Department of Gynecology, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250001, China
| | - Ying Liu
- Department of Dermatology, PLA 960 Hospital, Jinan, Shandong 250031, China
| | - Zhiyong Liu
- Central Laboratory, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250014, China; Institute for Literature and Culture of Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250014, China.
| | - Wei Shi
- Department of Gynecology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250014, China.
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Wang DG, Ji LM, Jia CL, Shao MJ. Effect of coexisting adenomyosis on tumour characteristics and prognosis of endometrial cancer: A systematic review and meta-analysis. Taiwan J Obstet Gynecol 2023; 62:640-650. [PMID: 37678989 DOI: 10.1016/j.tjog.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 09/09/2023] Open
Abstract
To compare clinicopathological features and survival outcomes in patients with endometrial cancer, with and without associated adenomyosis. PubMed, Embase and Scopus databases were systematically searched for relevant observational studies. The pooled effect sizes were reported as either hazards ratio (HR) for survival-related outcomes or as odds ratio (OR) for other categorical outcomes. Weighted mean difference (WMD) was reported for continuous outcomes. All the analyses used the random effects model. A total of 21 studies (N = 46,420) were included. Compared to endometrial cancer patients without adenomyosis, patients with associated adenomyosis had improved overall 5-year survival (OS) (HR 0.62, 95% CI: 0.50, 0.79) and disease-free survival (DFS) (HR 0.60, 95% CI: 0.44, 0.82). Disease-specific survival was statistically similar in patients with and without adenomyosis (HR 0.60, 95% CI: 0.35, 1.05). Among patients with adenomyosis, the risk of having an advanced tumour grade (Grade 2 or 3) was lower (OR 0.51, 95% CI: 0.42, 0.62) and a risk of having International Federation of Gynaecology and Obstetrics (FIGO) stage I or II was higher (OR 2.23, 95% CI: 1.65, 3.01). Patients with adenomyosis had lower risk of tumour invasion of adnexa, cervical stromal invasion, deep myometrial involvement (DMI), lympho-vascular space invasion (LVSI) and peritoneal invasion. Presence of adenomyosis in patients with endometrial cancer is associated with favourable tumour characteristics and may improve the survival.
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Affiliation(s)
- Dong-Ge Wang
- Department of Obstetrics and Gynecology, Jinhua Municipal Central Hospital, Jinhua, Zhejiang, 321000, China
| | - Li-Mei Ji
- Department of Obstetrics and Gynecology, Jinhua Municipal Central Hospital, Jinhua, Zhejiang, 321000, China
| | - Cen-Lin Jia
- Department of Obstetrics and Gynecology, Jinhua Municipal Central Hospital, Jinhua, Zhejiang, 321000, China
| | - Ming-Jun Shao
- Department of Obstetrics and Gynecology, Jinhua Municipal Central Hospital, Jinhua, Zhejiang, 321000, China.
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Maclean A, Barzilova V, Patel S, Bates F, Hapangama DK. Characterising the immune cell phenotype of ectopic adenomyosis lesions compared with eutopic endometrium: A systematic review. J Reprod Immunol 2023; 157:103925. [PMID: 36870297 DOI: 10.1016/j.jri.2023.103925] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/16/2023] [Accepted: 02/28/2023] [Indexed: 03/05/2023]
Abstract
Inflammation is implicated in the symptomatology and the pathogenesis of adenomyosis. Injury at the endo-myometrial interface causes inflammation and may facilitate the invasion of endometrium into the myometrium, forming adenomyosis lesions. Their presence causes local inflammation, resulting in heavy menstrual bleeding, chronic pelvic pain, and subfertility. Immunological differences have been described in the eutopic endometrium from women with adenomyosis compared to healthy endometrium, and differences are also expected in the adenomyotic lesions compared with the correctly sited eutopic endometrium. This systematic review retrieved relevant articles from three databases with additional manual citation chaining from inception to 24th October 2022. Twenty-two eligible studies were selected in accordance with PRISMA guidelines. Risk of bias assessments were performed, and the findings presented thematically. Ectopic endometrial stroma contained an increased density of macrophages compared with eutopic endometrium in adenomyosis. This was associated with an increase in pro-inflammatory cytokines (IL-6, IL-8, ILβ-1, C-X-C Motif Chemokine Receptor 1(CXCR1), Monocyte Chemoattractant Protein-1 (MCP-1)), and an imbalance of anti-inflammatory cytokines (IL-22, IL-37). Cells in ectopic lesions also contained a higher levels of toll-like receptors and immune-mediated enzymes. However, the studies were heterogeneous, with inconsistent reporting of immune cell density within epithelial or stromal compartments, and inclusion of samples from different menstrual cycle phases in the same group for analysis. A detailed understanding of the immune cell phenotypes present in eutopic and ectopic endometrium in adenomyosis and associated dysregulated inflammatory processes will provide further insight into the pathogenesis, to enable identification of fertility-sparing treatments as an alternative to hysterectomy.
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Affiliation(s)
- Alison Maclean
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L8 7SS, United Kingdom; Liverpool Women's Hospital NHS Foundation Trust, Member of Liverpool Health Partners, Liverpool L8 7SS, United Kingdom.
| | - Vanya Barzilova
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L8 7SS, United Kingdom
| | - Simran Patel
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L8 7SS, United Kingdom
| | - Faith Bates
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L8 7SS, United Kingdom; School of Life Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 7ZB, United Kingdom
| | - Dharani K Hapangama
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L8 7SS, United Kingdom; Liverpool Women's Hospital NHS Foundation Trust, Member of Liverpool Health Partners, Liverpool L8 7SS, United Kingdom
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Chen LH, Chan SH, Li CJ, Wu HM, Huang HY. Altered Expression of Interleukin-18 System mRNA at the Level of Endometrial Myometrial Interface in Women with Adenomyosis. Curr Issues Mol Biol 2022; 44:5550-5561. [PMID: 36354688 PMCID: PMC9689074 DOI: 10.3390/cimb44110376] [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: 09/24/2022] [Revised: 11/05/2022] [Accepted: 11/06/2022] [Indexed: 11/11/2022] Open
Abstract
Adenomyosis is a uterine pathology characterized by a deep invasion of endometrial glands and stroma, disrupting the endometrial−myometrial interface (EMI). Interleukin-18 (IL-18) system is a dominant cytokine involved in the menstrual cycle of human endometrium. IL-18 may play a defensive role against maternal immune response in the uterine cavity. The present study was designed to determine IL-18-mediated immune response at the level of EMI. We uncovered that mRNA of IL-18 system, including IL-18, IL-18 receptor (IL-18R), and its antagonist, IL-18 binding protein (IL-18BP), expressed in eutopic, ectopic endometrium, and corresponding myometrium in patients with adenomyosis. IL-18 system was demonstrated in paired tissue samples by immunochemistry and immunofluorescence study. According to RT-PCR with CT value quantification and 2−∆∆Ct method, a significant down-regulation of IL-18BP in corresponding myometrium in comparison to eutopic endometrium (p < 0.05) indicates that the IL-18 system acts as a local immune modulator at the level of EMI and regulating cytokine networks in the pathogenesis of adenomyosis. Furthermore, an increased IL-18 antagonist to agonist ratio was noted in ectopic endometrium compared with corresponding myometrium. We suggest that altered IL-18 system expression contributes to immunological dysfunction and junctional zone disturbance in women with adenomyosis.
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Affiliation(s)
- Liang-Hsuan Chen
- Department of Obstetrics and Gynecology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - She-Hung Chan
- Department of Obstetrics and Gynecology, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Cosmetic Science, Providence University, No. 200, Sec. 7, Taiwan Boulevard, Shalu Dist., Taichung 43301, Taiwan
| | - Chin-Jung Li
- Department of Obstetrics and Gynecology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Hsien-Ming Wu
- Department of Obstetrics and Gynecology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Hong-Yuan Huang
- Department of Obstetrics and Gynecology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
- Department of Obstetrics and Gynecology, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Correspondence:
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Effects of curcumin-piperine supplementation on systemic immunity in young women with premenstrual syndrome and dysmenorrhea: A randomized clinical trial. Eur J Obstet Gynecol Reprod Biol 2022; 278:131-136. [PMID: 36174434 DOI: 10.1016/j.ejogrb.2022.09.021] [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: 06/18/2022] [Revised: 09/14/2022] [Accepted: 09/20/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Premenstrual syndrome (PMS) and primary dysmenorrhea (PD) are common gynecological complications and there is evidence that inflammation may be an important factor in their etiology. There is a relationship between PMS and PD with susceptibility to allergic disorders. We aimed to assess the effect of curcumin co-administered with piperine on serum IL-10, IL-12 and IgE levels in patients with PD and PMS. MATERIALS AND METHODS A sample of 80 patients were recruited to this triple-blind, placebo-controlled clinical trial. Participants were randomly allocated to curcumin (n = 40) and control groups (n = 40). Each participant received one capsule (500 mg of curcuminoid plus piperine, or placebo) daily, from 7 days before until 3 days after menstruation for three consecutive menstrual cycles. RESULTS Serum IgE, IL-10 and IL-12 levels were quantified by using an ELISA kit. No significant differences were found between the two groups at baseline, including: age, BMI, and dietary intakes (P > 0.05). Curcumin + piperine treatment was associated with a significant reduction in the mean serum levels of IgE [from 223.6 ± 258.7 IU/mL to 161.3 ± 240.7; P = 0.001]; but there were no significant changes in the placebo group (P = 0.12). Serum concentrations of IL-10 and IL-12 before and after the trial period did not differ significantly between the two groups (P > 0.05). CONCLUSION Curcumin plus piperine might be have positive effect on serum IgE levels with no significant changes on serum IL-10 and IL-12 in healthy young women with PMS and PD. Studies with higher doses and longer durations of treatment with curcumin are required to confirm these findings.
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Qin X, Sun W, Wang C, Li M, Zhao X, Li C, Zhang H. Mifepristone inhibited the expression of B7-H2, B7-H3, B7-H4 and PD-L2 in adenomyosis. Reprod Biol Endocrinol 2021; 19:114. [PMID: 34289871 PMCID: PMC8293536 DOI: 10.1186/s12958-021-00800-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 07/11/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The immune mechanism was shown to be involved in the development of adenomyosis. The aim of the current study was to evaluate the expression of the immune checkpoints B7-H2, B7-H3, B7-H4 and PD-L2 in adenomyosis and to explore the effect of mifepristone on the expression of these immune checkpoints. METHODS The expression of B7-H2, B7-H3, B7-H4 and PD-L2 in normal endometria and adenomyosis patient samples treated with or without mifepristone was determined by immunohistochemistry analysis. RESULTS In adenomyosis patient samples, the expression of B7-H2, B7-H3 and B7-H4 was increased in the eutopic and ectopic endometria compared with normal endometria, both in the proliferative and secretory phases. Moreover, the expression of B7-H2 and B7-H3 was higher in adenomyotic lesions than in the corresponding eutopic endometria, both in the proliferative and secretory phases. The expression of PD-L2 was higher in adenomyotic lesions than in normal endometria in both the proliferative and secretory phases. In the secretory phase but not the proliferative phase, the expression of B7-H4 and PD-L2 in adenomyotic lesions was significantly higher than that in the corresponding eutopic endometria. In normal endometria and eutopic endometria, the expression of B7-H4 was elevated in the proliferative phase compared with that in the secretory phase, while in the ectopic endometria, B7-H4 expression was decreased in the proliferative phase compared with the secretory phase. In addition, the expression of B7-H2, B7-H3, B7-H4 and PD-L2 was significantly decreased in adenomyosis tissues after treatment with mifepristone. CONCLUSIONS The expression of the immune checkpoint proteins B7-H2, B7-H3, B7-H4 and PD-L2 is upregulated in adenomyosis tissues and is downregulated with mifepristone treatment. The data suggest that B7 immunomodulatory molecules are involved in the pathophysiology of adenomyosis.
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Affiliation(s)
- Xiaoyan Qin
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People's Republic of China
| | - Wenjing Sun
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People's Republic of China
| | - Chong Wang
- Department of Surgery, Shandong Rongjun General Hospital, Jinan, Shandong, 250013, People's Republic of China
| | - Mingjiang Li
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People's Republic of China
| | - Xingbo Zhao
- Department of Obstetrics and Gynaecology, Shandong University, Jinan, Shandong, 250000, People's Republic of China
| | - Changzhong Li
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People's Republic of China
| | - Hui Zhang
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People's Republic of China.
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Lin Y, Wang L, Ye M, Yu KN, Sun X, Xue M, Deng X. Activation of the cGAS-STING signaling pathway in adenomyosis patients. IMMUNITY INFLAMMATION AND DISEASE 2021; 9:932-942. [PMID: 34010983 PMCID: PMC8342233 DOI: 10.1002/iid3.452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 04/28/2021] [Accepted: 04/30/2021] [Indexed: 12/12/2022]
Abstract
Objective Adenomyosis is characterized by the presence of endometrium or endometrium‐like glands and stroma within the myometrium. In this study, we aimed to investigate whether the cGAS–STING pathway was activated and correlated with clinical outcomes in adenomyosis patients. Materials and Methods Twenty patients diagnosed with adenomyosis and 10 patients diagnosed with cervical intraepithelial neoplasia grade 3 (CIN‐3) but no adenomyosis were enrolled in this study. Specimens were collected during surgery from August 2017 to December 2017 at Third Xiangya Hospital. The messenger RNA (mRNA) and protein levels of key cGAS–STING pathway factors in uterine tissue were detected by real‐time reverse‐transcription polymerase chain reaction and immunohistochemistry, respectively. The correlations of gene expression and clinical outcomes, including dysmenorrhea and uterine volume, were analyzed. Results The cGAS, STING, TANK‐binding kinase 1 (TBK‐1), interferon‐α (IFN‐α), IFN‐β, and tumor necrosis factor‐α (TNF‐α) mRNA and protein levels in the ectopic endometrial tissue from adenomyosis patients were significantly higher compared with that from the controls in endometrium (p < .05). cGAS and STING gene expression were correlated with TBK‐1, IFN‐β, and TNF‐α expression (p < .05). Importantly, TBK‐1 and TNF‐α expression were correlated with the clinical outcome of dysmenorrhea (p < .05). Conclusion Our study reveals that the cGAS–STING pathway is activated in adenomyosis patients and its activation is subsequently correlated with clinical outcomes, which suggests that the cGAS–STING pathway may contribute to adenomyosis pathogenesis.
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Affiliation(s)
- Yun Lin
- Department of Obstetrics and Gynecology, The 3rd Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Luying Wang
- Department of Obstetrics and Gynecology, The 3rd Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Mingzhu Ye
- Department of Obstetrics and Gynecology, The 3rd Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Ke-Nan Yu
- Department of Obstetrics and Gynecology, The 3rd Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xin Sun
- Department of Obstetrics and Gynecology, The 3rd Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Min Xue
- Department of Obstetrics and Gynecology, The 3rd Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xinliang Deng
- Department of Obstetrics and Gynecology, The 3rd Xiangya Hospital of Central South University, Changsha, Hunan, China
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8
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Bourdon M, Santulli P, Jeljeli M, Vannuccini S, Marcellin L, Doridot L, Petraglia F, Batteux F, Chapron C. Immunological changes associated with adenomyosis: a systematic review. Hum Reprod Update 2020; 27:108-129. [PMID: 33099635 DOI: 10.1093/humupd/dmaa038] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 07/24/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Adenomyosis is a benign gynecological disorder associated with subfertility, pelvic pain and abnormal uterine bleeding that have significant consequences for the health and quality of life of women. Histologically, it is defined as the presence of ectopic endometrial islets within the myometrium. Its pathogenesis has not yet been elucidated and several pieces of the puzzle are still missing. One process involved in the development of adenomyosis is the increased capacity of some endometrial cells to infiltrate the myometrium. Moreover, the local and systemic immune systems are associated with the onset of the disease and with maintaining it. Numerous observations have highlighted the activation of immune cells and the release of immune soluble factors in adenomyosis. The contribution of immunity occurs in conjunction with hormonal aberrations and activation of the epithelial to mesenchymal transition (EMT) pathway, which promotes migration of endometrial cells. Here, we review current knowledge on the immunological changes in adenomyosis, with the aim of further elucidation of the pathogenesis of this disease. OBJECTIVE AND RATIONALE The objective was to systematically review the literature regarding the role of the immune system in development of adenomyosis in the inner and the outer myometrium, in humans. SEARCH METHODS A systematic review of published human studies was performed in MEDLINE, EMBASE and Cochrane Library databases from 1970 to February 2019 using the combination of Medical Subject Headings (MeSH): Adenomyosis AND ('Immune System' OR 'Gonadal Steroid Hormones'), and free-text terms for the following search terms (and their variants): Adenomyosis AND (immunity OR immune OR macrophage OR 'natural killer cell' OR lymphocyte* OR leucocyte* OR HLA OR inflammation OR 'sex steroid' OR 'epithelial to mesenchymal transition' OR 'EMT'). Studies in which no comparison was made with control patients, without adenomyosis (systemic sample and/or eutopic endometrium), were excluded. OUTCOMES A total of 42 articles were included in our systematic review. Changes in innate and adaptive immune cell numbers were described in the eutopic and/or ectopic endometrium of women with adenomyosis compared to disease-free counterparts. They mostly described an increase in lymphocyte and macrophage cell populations in adenomyosis eutopic endometrium compared to controls. These observations underscore the immune contributions to the disease pathogenesis. Thirty-one cytokines and other markers involved in immune pathways were studied in the included articles. Pro-inflammatory cytokines (interleukin (IL) 6, IL1β, interferon (IFN) α, tumor necrosis factor α, IFNγ) as well as anti-inflammatory or regulatory mediators (IL10, transforming growth factor β…) were found to be elevated in the eutopic endometrium and/or in the ectopic endometrium of the myometrium in women with adenomyosis compared to controls. Moreover, in women affected by adenomyosis, immunity was reported to be directly or indirectly linked to sex steroid hormone aberrations (notably changes in progesterone receptor in eutopic and ectopic endometrium) in three studies and to EMT in four studies. WIDER IMPLICATIONS The available literature clearly depicts immunological changes that are associated with adenomyosis. Both systemic and local immune changes have been described in women affected by adenomyosis, with the coexistence of changes in inflammatory as well as anti-inflammatory signals. It is likely that these immune changes, through an EMT mechanism, stimulate the migration of endometrial cells into the myometrium that, together with an endocrine imbalance, promote this inflammatory process. In light of the considerable impact of adenomyosis on women's health, a better understanding of the role played by the immune system in adenomyosis is likely to yield new research opportunities to better understand its pathogenesis.
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Affiliation(s)
- M Bourdon
- Université de Paris, Faculté de Médecine, Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, 27, rue du Faubourg-Saint-Jacques, 75015 Paris, France.,Department 3I "Infection, Immunité et inflammation", Institut Cochin, INSERM U1016, Paris, France.,Department of Gynaecology Obstetrics and Reproductive Medicine, Hopital Cochin, Paris, France
| | - P Santulli
- Université de Paris, Faculté de Médecine, Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, 27, rue du Faubourg-Saint-Jacques, 75015 Paris, France.,Department 3I "Infection, Immunité et inflammation", Institut Cochin, INSERM U1016, Paris, France.,Department of Gynaecology Obstetrics and Reproductive Medicine, Hopital Cochin, Paris, France
| | - M Jeljeli
- Université de Paris, Faculté de Médecine, Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, 27, rue du Faubourg-Saint-Jacques, 75015 Paris, France.,Department 3I "Infection, Immunité et inflammation", Institut Cochin, INSERM U1016, Paris, France.,Department of Immunology, Hopital Cochin, Paris, France
| | - S Vannuccini
- Division of Obstetrics and Gynecology, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Viale Morgagni 44, 50134 Florence, Italy.,Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - L Marcellin
- Université de Paris, Faculté de Médecine, Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, 27, rue du Faubourg-Saint-Jacques, 75015 Paris, France.,Department 3I "Infection, Immunité et inflammation", Institut Cochin, INSERM U1016, Paris, France.,Department of Gynaecology Obstetrics and Reproductive Medicine, Hopital Cochin, Paris, France
| | - L Doridot
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, 27, rue du Faubourg-Saint-Jacques, 75015 Paris, France.,Department 3I "Infection, Immunité et inflammation", Institut Cochin, INSERM U1016, Paris, France
| | - F Petraglia
- Division of Obstetrics and Gynecology, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Viale Morgagni 44, 50134 Florence, Italy
| | - F Batteux
- Université de Paris, Faculté de Médecine, Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, 27, rue du Faubourg-Saint-Jacques, 75015 Paris, France.,Department 3I "Infection, Immunité et inflammation", Institut Cochin, INSERM U1016, Paris, France.,Department of Immunology, Hopital Cochin, Paris, France
| | - C Chapron
- Université de Paris, Faculté de Médecine, Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, 27, rue du Faubourg-Saint-Jacques, 75015 Paris, France.,Department 3I "Infection, Immunité et inflammation", Institut Cochin, INSERM U1016, Paris, France.,Department of Gynaecology Obstetrics and Reproductive Medicine, Hopital Cochin, Paris, France
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9
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Abstract
Adenomyosis is a common disorder of the uterus, and is associated with an enlarged uterus, heavy menstrual bleeding (HMB), pelvic pain, and infertility. It is characterized by endometrial epithelial cells and stromal fibroblasts abnormally found in the myometrium where they elicit hyperplasia and hypertrophy of surrounding smooth muscle cells. While both the mechanistic processes and the pathogenesis of adenomyosis are uncertain, several theories have been put forward addressing how this disease develops. These include intrinsic or induced (1) microtrauma of the endometrial-myometrial interface; (2) enhanced invasion of endometrium into myometrium; (3) metaplasia of stem cells in myometrium; (4) infiltration of endometrial cells in retrograde menstrual effluent into the uterine wall from the serosal side; (5) induction of adenomyotic lesions by aberrant local steroid and pituitary hormones; and (6) abnormal uterine development in response to genetic and epigenetic modifications. Dysmenorrhea, HMB, and infertility are likely results of inflammation, neurogenesis, angiogenesis, and contractile abnormalities in the endometrial and myometrial components. Elucidating mechanisms underlying the pathogenesis of adenomyosis raise possibilities to develop targeted therapies to ameliorate symptoms beyond the current agents that are largely ineffective. Herein, we address these possible etiologies and data that support underlying mechanisms.
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Affiliation(s)
- Junyu Zhai
- Department of Obstetrics, Gynecology and Reproductive Sciences, Center for Reproductive Sciences, University of California, San Francisco, San Francisco, California
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, People’s Republic of China
| | - Silvia Vannuccini
- Division of Obstetrics and Gynecology, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Careggi University Hospital, Florence, Italy
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Felice Petraglia
- Division of Obstetrics and Gynecology, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Careggi University Hospital, Florence, Italy
| | - Linda C. Giudice
- Department of Obstetrics, Gynecology and Reproductive Sciences, Center for Reproductive Sciences, University of California, San Francisco, San Francisco, California
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10
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Abstract
Adenomyosis represents a unique pathophysiological condition in which normal-appearing endometrial mucosa resides within myometrium and is thus protected from menstrual shedding. The resulting ectopic presence of endometrial tissue composed of glands and stroma is thought to affect normal contractile function and peristalsis of uterine smooth muscle, causing menometrorrhagia, infertility, and adverse obstetric outcomes. Since the first description of adenomyosis more than 150 years ago, pathologists have studied this lesion by examining tissue specimens, and have proposed multiple explanations to account for its pathogenesis. However, as compared with endometriosis, progress of adenomyosis research has been, at best, incremental mainly due to the lack of standardized protocols in sampling tissue and a lack of consensus diagnostic criteria in pathology practice. Despite these limitations, recent advances in revealing the detailed anatomy and biology of eutopic endometrium offer an unprecedented opportunity to study this common but relatively understudied disorder. Here, we briefly summarize the pathological aspects of adenomyosis from an historical background, and discuss conventional morphology and recent tissue-based molecular studies with a special emphasis on elucidating its tissue of origin from a pathologist's perspective. We also discuss unmet needs in pathology studies that would be important for advancing adenomyosis research.
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Affiliation(s)
- Maria Facadio Antero
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ayse Ayhan
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - James Segars
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ie-Ming Shih
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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11
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Du L, Du DH, Chen B, Ding Y, Zhang T, Xiao W. Anti-Inflammatory Activity of Sanjie Zhentong Capsule Assessed By Network Pharmacology Analysis of Adenomyosis Treatment. DRUG DESIGN DEVELOPMENT AND THERAPY 2020; 14:697-713. [PMID: 32109994 PMCID: PMC7039068 DOI: 10.2147/dddt.s228721] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 02/08/2020] [Indexed: 12/23/2022]
Abstract
Background Sanjie Zhentong capsule (SZC) offers excellent effect in treating adenomyosis (AM), which is a common and difficult gynecological disease in the clinic. However, the systematic analysis of its mechanism has not been carried out yet and further studies are needed to reveal the role of SZC. Methods A systematic network pharmacology analysis was conducted by integrating construction of SZC compound database and AM target database, prediction of potential active compounds and targets by molecular docking combined with compound-target prediction graph (CTPG), protein-protein interaction (PPI) analysis, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis. Then, the anti-inflammation experiments in vitro were performed by investigating SZC and the representative compounds regulating nitric oxide (NO), interleukin-6 (IL-6), and interleukin-10 (IL-10). Results Our findings show that SZC mainly treated AM by stimulating 28 core targets through 30 key potential active compounds, and affecting 4 crucial pathways. The treatment was associated with inflammation reaction, hormone regulation, cell adhesion, proliferation, and angiogenesis. Additionally, SZC achieved the anti-inflammatory activity by the cooperation of the compounds through inhibiting NO and IL-6, both promoting and inhibiting IL-10. Conclusion This study investigated the anti-inflammatory activity of SZC based on a systematic analysis of SZC remedying AM, which was revealed to be one of the essential mechanisms. These findings will provide valuable guidance for further research of the SZC treatment of AM, and help improve the comprehension of SZC pharmacological basis as well as AM pathogenesis.
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Affiliation(s)
- Li Du
- Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - De-Hui Du
- Shanghai Key Laboratory of Trustworthy Computing and Software Engineering Institute, East China Normal University, Shanghai, People's Republic of China
| | - Biao Chen
- Shanghai Key Laboratory of Trustworthy Computing and Software Engineering Institute, East China Normal University, Shanghai, People's Republic of China
| | - Yue Ding
- Experiment Center for Teaching and Learning, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Tong Zhang
- Experiment Center for Teaching and Learning, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Wei Xiao
- Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China.,Jiangsu Kanion Pharmaceutical Co., Ltd, Jiangsu, People's Republic of China
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Decreased Endometrial IL-10 Impairs Endometrial Receptivity by Downregulating HOXA10 Expression in Women with Adenomyosis. BIOMED RESEARCH INTERNATIONAL 2018; 2018:2549789. [PMID: 30687738 PMCID: PMC6330834 DOI: 10.1155/2018/2549789] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/24/2018] [Accepted: 12/11/2018] [Indexed: 01/29/2023]
Abstract
Objective The aim of this study was to investigate the potential role of IL-10 in regulating the receptivity marker HOXA10 in the endometrium of women with adenomyosis. Methods The expression levels of IL-10, HOXA-10, STAT3, and p-STAT3 in the endometrium of women with adenomyosis and controls were examined by means of western blotting and immunohistochemistry. The expression of the HOXA10 protein in Ishikawa cells treated with rIL-10 was examined by western blotting. The attachment rate of BeWo cell spheroids to Ishikawa cells treated with rIL-10 was expressed as a percentage of the total number of spheroids. Results The expression levels of HOXA10 and IL-10 in the adenomyosis group were significantly lower than those in the control group, and there was a positive correlation between HOXA10 and IL-10 protein levels in all the women examined. rIL-10 increased HOXA10 expression in a concentration- and time-dependent manner by inducing the phosphorylation of STAT3 in Ishikawa cells. Treatment with rIL-10 promoted the attachment of BeWo spheroids to Ishikawa cells, which was reversed by the inhibition of STAT3 phosphorylation. The expression of p-STAT3 in the adenomyosis group was significantly lower than that in the control group, and there was a positive correlation between IL-10 and p-STAT3 protein levels in all the women examined. Conclusions Both IL-10 and HOXA10 levels in the endometrium are significantly reduced in women with adenomyosis compared with those in control women. The phosphorylation of STAT3 has been proven to be a critical mediator between IL-10 and HOXA10, which may play critical roles in embryo implantation.
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Bourdon M, Santulli P, Chouzenoux S, Maignien C, Bailly K, Andrieu M, Millischer AE, Doridot L, Marcellin L, Batteux F, Chapron C. The Disease Phenotype of Adenomyosis-Affected Women Correlates With Specific Serum Cytokine Profiles. Reprod Sci 2018; 26:198-206. [DOI: 10.1177/1933719118816852] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Mathilde Bourdon
- Department of Gynaecology Obstetrics II and Reproductive Medicine, Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Assistance Publique–Hôpitaux de Paris (AP–HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department “Development, Reproduction and Cancer”, Institut Cochin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Pietro Santulli
- Department of Gynaecology Obstetrics II and Reproductive Medicine, Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Assistance Publique–Hôpitaux de Paris (AP–HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department “Development, Reproduction and Cancer”, Institut Cochin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Sandrine Chouzenoux
- Department “Development, Reproduction and Cancer”, Institut Cochin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Chloé Maignien
- Department of Gynaecology Obstetrics II and Reproductive Medicine, Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Assistance Publique–Hôpitaux de Paris (AP–HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
| | - Karine Bailly
- Institut Cochin, Plateforme de Cytométrie et d’Immuno-Biologie (CYBIO), Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Muriel Andrieu
- Institut Cochin, Plateforme de Cytométrie et d’Immuno-Biologie (CYBIO), Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | | | - Ludivine Doridot
- Department “Development, Reproduction and Cancer”, Institut Cochin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Louis Marcellin
- Department of Gynaecology Obstetrics II and Reproductive Medicine, Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Assistance Publique–Hôpitaux de Paris (AP–HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department “Development, Reproduction and Cancer”, Institut Cochin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Fréderic Batteux
- Department “Development, Reproduction and Cancer”, Institut Cochin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Charles Chapron
- Department of Gynaecology Obstetrics II and Reproductive Medicine, Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Assistance Publique–Hôpitaux de Paris (AP–HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department “Development, Reproduction and Cancer”, Institut Cochin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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Fan YY, Chen HY, Chen W, Liu YN, Fu Y, Wang LN. Expression of inflammatory cytokines in serum and peritoneal fluid from patients with different stages of endometriosis. Gynecol Endocrinol 2018; 34:507-512. [PMID: 29308924 DOI: 10.1080/09513590.2017.1409717] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To investigate the level of inflammatory cytokines in endometriosis patients, and explore the relationship between IL-37 concentration and endometriosis stages. METHODS Inflammatory cytokine concentrations from 27 patients with different stages of endometriosis and 52 controls without endometriosis were examined by ELISA. Then, the specificity and sensitivity of cytokines for distinguishing from controls and the different stages of endometriosis were analyzed using the ROC curve. RESULTS The difference in serum concentrations of IL-37, IL-17A, IL-10, and IL-2 between the endometriosis and control groups was statistically significant (p < .01). Compared with controls, significantly higher levels of serum IL-37 and IL-10, and significantly lower levels of serum IL-17A and IL-2 were detected in patients with endometriosis (p < .01). Furthermore, IL-2 concentration was significantly higher in peritoneal fluid (PF) in the endometriosis group (p = .0034), IL-10 concentrations in PF were significantly lower in the early-stages of endometriosis than in the more advanced groups (p = .0439), and IL-4 concentration in PF was significantly higher in more advanced endometriosis (p = .0228). The sensitivity and specificity of serum IL-37 for distinguishing endometriosis were 81.48% and 83.33%, respectively, and the cutoff concentration was 69.84 pg/ml. For IL-17A, the sensitivity and specificity were 96.30% and 100%, respectively, and the cutoff concentration was 57.54 pg/ml. For IL-10, the sensitivity and specificity was 92.59% and 100%, respectively, and the cutoff concentration was 3.301 pg/ml. For IL-2, the sensitivity and specificity were 74.07% and 93.75%, respectively, and the cutoff concentration was 1.813 pg/ml. For PF IL-2, the sensitivity and specificity were 29.73% and 100%, respectively, and the cutoff concentration was 1.06 pg/ml. CONCLUSIONS IL-37, IL-17A, IL-10, and IL-2 may play a significant role in immune response in endometriosis. IL-37 levels may be used as a diagnostic marker for endometriosis.
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Affiliation(s)
- Yan-Yan Fan
- a Department of Obstetrics and Gynecology , The First Hospital of Jilin University , Changchun , China
| | - Hong-Yu Chen
- b Peking University of Medical Department , Beijing , China
| | - Wei Chen
- c Department of Orthopedic China-Japan Friendship Hospital Affiliated to Jilin University , Changchun , China
| | - Yi-Nan Liu
- d Department of Otorhinolaryngology , The Fourth Hospital of Jilin University , Changchun , China
| | - Yan Fu
- a Department of Obstetrics and Gynecology , The First Hospital of Jilin University , Changchun , China
| | - Li-Na Wang
- a Department of Obstetrics and Gynecology , The First Hospital of Jilin University , Changchun , China
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15
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Soave I, Wenger JM, Pluchino N, Marci R. Treatment options and reproductive outcome for adenomyosis-associated infertility. Curr Med Res Opin 2018; 34:839-849. [PMID: 29046066 DOI: 10.1080/03007995.2017.1393404] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Adenomyosis is a benign gynecological disease mostly diagnosed in the forth and fifth decades. The recent improvement of the diagnostic tools and a better understanding of the pathology allowed clinicians to postulate a possible relationship between adenomyosis and infertility and to diagnose it in younger asymptomatic women during infertility work-up. Purpose of this article is to review the different theories regarding the possible correlation between adenomyosis and infertility and to discuss the treatment options and the final reproductive outcome after the treatment. MATERIALS AND METHODS We search Pubmed for articles published in the English language with the use of the following MeSH search terms: "adenomyosis" combined with "treatment" and "fertility outcome" with the restriction to the human species. A manual search of review articles and cross-references completed the search. All selected articles were assessed for study design, patients characteristic, diagnosis of adenomyosis, type of treatment, post-treatment rates of conception, full-term pregnancy and completeness of information of the data sets. RESULTS Limited data are available concerning the efficacy of the different treatment options of adenomyosis on fertility outcome and the only ones published are retrospective evaluations or small case series. CONCLUSIONS Adenomyosis represents a common gynecological disorder with a negative impact on fertility. However, it remains challenging to establish if adenomyosis is the only cause of the infertility or not, because patients, in both case and control groups, may be affected by concomitant endometriosis. Further studies are required to determine the reason of implantation failure in women with adenomyosis and the impact of adenomyosis on infertile women with or without endometriosis.
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Affiliation(s)
- Ilaria Soave
- a Department of Morphology, Surgery and Experimental Medicine , University of Ferrara , Ferrara , Italy
| | - Jean-Marie Wenger
- b Division of Obstetrics and Gynecology , University Hospital of Geneva , Geneva , Switzerland
| | - Nicola Pluchino
- b Division of Obstetrics and Gynecology , University Hospital of Geneva , Geneva , Switzerland
| | - Roberto Marci
- a Department of Morphology, Surgery and Experimental Medicine , University of Ferrara , Ferrara , Italy
- b Division of Obstetrics and Gynecology , University Hospital of Geneva , Geneva , Switzerland
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16
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Jiang JF, Xiao SS, Xue M. Decreased expression of interleukin-37 in the ectopic and eutopic endometria of patients with adenomyosis. Gynecol Endocrinol 2018; 34:83-86. [PMID: 28762845 DOI: 10.1080/09513590.2017.1354367] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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
Previous studies have shown that alterations of cytokines might play a role in the pathogenesis of adenomyosis. This study aims to investigate the expression of interleukin-37 (IL-37), an anti-inflammatory cytokine, in the eutopic and ectopic endometria of patients with adenomyosis. Endometrial specimens were collected from 30 women with adenomyosis and 20 without adenomyosis. The gene and protein expression of IL-37 was measured using a quantitative real-time polymerase chain reaction and immunohistochemistry, respectively. Compared with the control endometria, the protein expression level and gene level of IL-37 was significantly lower in both the ectopic and eutopic endometria of patients with adenomyosis. The gene and protein expressions of IL-37 in ectopic endometria were lower than those in eutopic endometria of patients with adenomyosis. Our results suggest that there was a low level of IL-37 in the eutopic and ectopic endometria of patients with adenomyosis, and an abnormal inflammatory response might occur in the endometria of patients with adenomyosis.
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Affiliation(s)
- Jian Fa Jiang
- a From the Department of Obstetrics and Gynecology , The Third Xiangya Hospital of Central South University , Changsha , Hunan , China
| | - Song Shu Xiao
- a From the Department of Obstetrics and Gynecology , The Third Xiangya Hospital of Central South University , Changsha , Hunan , China
| | - Min Xue
- a From the Department of Obstetrics and Gynecology , The Third Xiangya Hospital of Central South University , Changsha , Hunan , China
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Vannuccini S, Tosti C, Carmona F, Huang SJ, Chapron C, Guo SW, Petraglia F. Pathogenesis of adenomyosis: an update on molecular mechanisms. Reprod Biomed Online 2017; 35:592-601. [DOI: 10.1016/j.rbmo.2017.06.016] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 04/13/2017] [Accepted: 06/13/2017] [Indexed: 12/15/2022]
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Rhein ameliorates adenomyosis by inhibiting NF-κB and β-Catenin signaling pathway. Biomed Pharmacother 2017; 94:231-237. [DOI: 10.1016/j.biopha.2017.07.089] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 07/17/2017] [Accepted: 07/19/2017] [Indexed: 01/06/2023] Open
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Tamura H, Kishi H, Kitade M, Asai-Sato M, Tanaka A, Murakami T, Minegishi T, Sugino N. Clinical outcomes of infertility treatment for women with adenomyosis in Japan. Reprod Med Biol 2017; 16:276-282. [PMID: 29259478 PMCID: PMC5715885 DOI: 10.1002/rmb2.12036] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 04/15/2017] [Indexed: 01/11/2023] Open
Abstract
Aim A multicenter, retrospective survey was conducted in order to investigate the current clinical status of adenomyosis in Japan. Methods The questionnaires covered the management of infertile women with adenomyosis and the outcomes of infertility treatment in women with adenomyosis. The questionnaires were sent to 1149 facilities in Japan. Results The data were obtained on 535 infertile women with adenomyosis from 190 facilities. Regarding management, infertility treatment was performed without pretreatment for adenomyosis in 37 facilities, after medication in eight facilities, and after an operation in four facilities. Management policies were not established in 106 facilities. Regarding outcomes, the pregnancy rate was 41.7% and the abortion rate was 29.8%. Eighty‐five patients received medication and 89 patients underwent surgery as a pretreatment before infertility treatment, while 361 patients had no pretreatment. In relation to the type of adenomyosis, 162 patients had the focal type and 336 patients had the diffuse type. The pregnancy rate and abortion rate were not affected by pretreatment or the type of adenomyosis. Conclusion The management policy for infertile women with adenomyosis has not been established. The pregnancy rate of infertility treatment is about 40%. There were no data to suggest that medication or surgery as a pretreatment for adenomyosis increased the pregnancy rate in infertile women.
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Affiliation(s)
- Hiroshi Tamura
- Department of Obstetrics and Gynecology Yamaguchi University Graduate School of Medicine Ube Japan
| | - Hiroshi Kishi
- Department of Obstetrics and Gynecology Gunma University Graduate School of Medicine Maebashi Japan
| | - Mari Kitade
- Department of Obstetrics and Gynecology Juntendo University School of Medicine Tokyo Japan
| | - Mikiko Asai-Sato
- Department of Obstetrics and Gynecology Yokohama City University Hospital Yokohama Japan
| | - Atsushi Tanaka
- Saint Mother Obstetrics and Gynecology Clinic Institute for ART Fukuoka Japan
| | - Takashi Murakami
- Department of Obstetrics and Gynecology Shiga University of Medical Science Otsu Japan
| | - Takashi Minegishi
- Department of Obstetrics and Gynecology Gunma University Graduate School of Medicine Maebashi Japan
| | - Norihiro Sugino
- Department of Obstetrics and Gynecology Yamaguchi University Graduate School of Medicine Ube Japan
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Machida H, Maeda M, Cahoon SS, Scannell CA, Garcia-Sayre J, Roman LD, Matsuo K. Endometrial cancer arising in adenomyosis versus endometrial cancer coexisting with adenomyosis: are these two different entities? Arch Gynecol Obstet 2017; 295:1459-1468. [PMID: 28444512 DOI: 10.1007/s00404-017-4375-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 04/18/2017] [Indexed: 12/30/2022]
Abstract
PURPOSE While adenomyosis is one of the most common benign histologic findings in hysterectomy specimens of endometrial cancer, demographics of endometrial cancer arising in adenomyosis (EC-AIA) has not been well elucidated. The aim of this study is to evaluate histopathological findings and disease-free survival (DFS) of EC-AIA in comparison to endometrial cancer coexisting with adenomyosis (EC-A). METHODS EC-AIA cases were identified via a systematic literature search (n = 46). EC-A cases were identified from a historical cohort that underwent hysterectomy-based surgical staging in two institutions (n = 350). Statistical comparisons of the two groups were based on univariate and multivariate analyses. RESULTS The EC-AIA group was significantly older than the EC-A group (58.9 versus 53.8, p = 0.002). As to tumor characteristics, 63.6% of EC-AIA cases reported tumor within the myometrium without endometrial extension. The EC-AIA group was significantly associated with more non-endometrioid histology (23.9 versus 14.8%; p = 0.002) and deep myometrial tumor invasion (51.6 versus 19.4%; p < 0.001) than EC-A. Tumor grade, stage, and nodal metastasis risk were similar (all, p > 0.05). In a univariate analysis, the EC-AIA group had a significantly decreased DFS compared to EC-A (5-year rates, 72.2 versus 85.5%, p = 0.001). After controlling for age, histology, tumor grade, and stage, EC-AIA remained an independent prognostic factor associated with decreased DFS compared to EC-A (adjusted-hazard ratio 2.87, 95% confidence interval 1.44-5.70, p = 0.031). CONCLUSION Our study demonstrated that EC-AIA has distinct tumor characteristics and a poorer survival outcome compared to EC-A. This suggests a benefit of recognition of this unique entity as an aggressive variant of endometrial cancer.
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Affiliation(s)
- Hiroko Machida
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, 2020 Zonal Avenue, IRD 520, Los Angeles, CA, 90089, USA
| | - Midori Maeda
- National Center for Global Health and Medicine, Tokyo, Japan
| | - Sigita S Cahoon
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, 2020 Zonal Avenue, IRD 520, Los Angeles, CA, 90089, USA
| | | | - Jocelyn Garcia-Sayre
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, 2020 Zonal Avenue, IRD 520, Los Angeles, CA, 90089, USA
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, 2020 Zonal Avenue, IRD 520, Los Angeles, CA, 90089, USA.,Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, 2020 Zonal Avenue, IRD 520, Los Angeles, CA, 90089, USA. .,Norris Comprehensive Cancer Center, Los Angeles, CA, USA.
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Abstract
Until recently, adenomyosis has been associated with multiparity, not impaired fertility. Currently, adenomyosis is diagnosed with increasing frequency in infertile patients since women delay their first pregnancy until their late 30s or early 40s. Although an association between adenomyosis and infertility has not been fully established, based on the available information, recent studies suggested that adenomyosis has a negative impact on female fertility. Several uncontrolled studies with limited data also suggested that treatment of adenomyosis may improve fertility. This article discusses (i) the hypothesis and epidemiology of adenomyosis, (ii) diagnostic techniques, (iii) clinical evidence of correlation between adenomyosis and infertility, (iv) proposed mechanism of infertility in women with adenomyosis, (v) different treatment strategies and reproductive outcomes, and (vi) assisted reproductive technology outcome in women with adenomyosis.
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Yen CF, Huang SJ, Lee CL, Wang HS, Liao SK. Molecular Characteristics of the Endometrium in Uterine Adenomyosis and Its Biochemical Microenvironment. Reprod Sci 2017; 24:1346-1361. [PMID: 28183227 DOI: 10.1177/1933719117691141] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Adenomyosis, which manifests with focally or diffusely scattered endometrial tissue within the uterine myometrium, is an endometriosis-like disease with controversial pathogenesis and compromised reproductive outcomes. This review, including the in vitro and in vivo studies performed on human or mouse models, is aimed to summarize the specific molecular characteristics of endometrium in the biochemical microenvironments of uterine adenomyosis. Many studies attributed the endometrium as the main cause of pathogenesis, with evidence of differential genetic expression and/or epigenetic modulation as well as estrogen-induced epithelial-mesenchymal transition. However, some studies indicated that the myometrium could play a role in the development of disease, based on findings of smooth muscle metaplasia and/or fibroblast-to-myofibroblast transdifferentiation by the influence of local biochemical factors. To date, it remains unclear whether adenomyosis is a genetically determined or a microenvironmentally induced disorder or whether the dysregulation of local factors may elicit the alteration of genetic expression in the endometrium. Similarly, it is uncertain whether the endometrial characteristics would remain consistent or could change along with a woman's reproductive life. Further longitudinal studies of the epigenetic controls or system biology are needed to elucidate the pathogenesis. Discovery of effective conservative treatments to improve the reproductive outcomes of patients with adenomyosis is still warranted.
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Affiliation(s)
- Chih-Feng Yen
- 1 Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital, Kwei-Shan, Tao-Yuan, Taiwan.,2 Department of Obstetrics and Gynecology, Chang Gung University College of Medicine, Kwei-Shan, Tao-Yuan, Taiwan.,3 Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - S Joseph Huang
- 4 Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.,5 Department of Obstetrics and Gynecology, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Chyi-Long Lee
- 2 Department of Obstetrics and Gynecology, Chang Gung University College of Medicine, Kwei-Shan, Tao-Yuan, Taiwan.,6 Department of Obstetrics and Gynecology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Hsin-Shih Wang
- 1 Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital, Kwei-Shan, Tao-Yuan, Taiwan.,2 Department of Obstetrics and Gynecology, Chang Gung University College of Medicine, Kwei-Shan, Tao-Yuan, Taiwan.,3 Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Shuen-Kuei Liao
- 2 Department of Obstetrics and Gynecology, Chang Gung University College of Medicine, Kwei-Shan, Tao-Yuan, Taiwan.,7 The PhD Program of Cancer Biology and Drug Discovery, Center of Excellence for Cancer Research, Taipei Medical University, Taipei, Taiwan
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Current and Future Medical Treatment of Adenomyosis. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2016. [DOI: 10.5301/je.5000261] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Adenomyosis is a benign gynecological disorder associated with abnormal uterine bleeding, dysmenorrhea, dyspareunia and infertility, requiring a life-long management plan through medical or surgical treatment. The choice depends on woman's age, reproductive status and clinical symptoms. However, until now no drug labelled for adenomyosis is available; thus, the present review will focus on medical treatments currently used for adenomyosis and those in development. Adenomyosis may be considered a sex steroid hormone-related disorder associated with an intense inflammatory process. The use of gonadotropin-releasing hormone agonists (GnRH-a) for treating adenomyosis is described blocking the hypothalamic-pituitary-gonadal axis; however, it has long been associated with frequent and intolerable hypoestrogenic side effects. An antiproliferative effect of progestins suggests their use for treating adenomyosis, reducing bleeding and pain. Continuous oral norethisterone acetate or medroxyprogesterone acetate may help to inducing regression of adenomyosis, relief pain and reduce bleeding. The use of vaginal danazol has therapeutic effect on adenomyosis combining progestogenic and anti-inflammatory activity. The intrauterine device releasing levonorgestrel (Lng-IUD) is widely assessed in menorrhagia, and has been shown to be extremely effective in resolving pain and bleeding symptoms associated with adenomyosis. Recent data show a therapeutic effect of dienogest on adenomyosis symptoms. New drugs are under development for the treatment of adenomyosis, such as aromatase inhibitors (AIs) and selective estrogen receptor modulators (SERMs), that produce a hypoestrogenic environment reducing pain, but are correlated with some adverse effects and a recurrence of symptoms after discontinuation of treatment. Selective progesterone receptor modulators (SPRMs) may reduce adenomyosis-associated pelvic pain, by inhibiting endometrial proliferation and suppressing adenomyotic lesion growth, as shown in animal models; however, the long-term effect with SPRMs needs further determination.
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Correlation between Cyr61 expression and clinicopathologic parameters in adenomyosis. J Reprod Immunol 2016; 118:42-49. [DOI: 10.1016/j.jri.2016.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 08/03/2016] [Accepted: 08/15/2016] [Indexed: 01/22/2023]
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Carrarelli P, Yen CF, Funghi L, Arcuri F, Tosti C, Bifulco G, Luddi A, Lee CL, Petraglia F. Expression of Inflammatory and Neurogenic Mediators in Adenomyosis. Reprod Sci 2016; 24:369-375. [DOI: 10.1177/1933719116657192] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Patrizia Carrarelli
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Chih-Feng Yen
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Taipei, Taiwan
| | - Lucia Funghi
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Felice Arcuri
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Claudia Tosti
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Giuseppe Bifulco
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples “Federico II,” Naples, Italy
| | - Alice Luddi
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Chyi-Long Lee
- Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Obstetrics and Gynecology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Felice Petraglia
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
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Increased expression of nuclear factor kappa-B p65 subunit in adenomyosis. Obstet Gynecol Sci 2016; 59:123-9. [PMID: 27004203 PMCID: PMC4796082 DOI: 10.5468/ogs.2016.59.2.123] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 10/12/2015] [Accepted: 10/15/2015] [Indexed: 11/30/2022] Open
Abstract
Objective Nuclear factor kappa-B (NF-κB) is a critical proinflammatory regulator that has been suggested to play a pivotal role in the pathogenesis and pathophysiology of endometriosis. In the present study, we aimed to evaluate whether the expression of NF-κB p65 subunit is increased in the eutopic endometrium and/or in the adenomyosis nodule of women with adenomyosis. Methods Thirty-three women with histologically confirmed adenomyosis after laparoscopic or transabdominal hysterectomy were recruited. Women with carcinoma in situ of uterine cervix without evidence of adenomyosis or endometriosis (n=32) served as controls. Formalin-fixed, paraffin-embedded archival tissues were sectioned and immunostained utilizing a monoclonal anti-human NF-κB p65 subunit antibody, and the immunoreactivity of NF-κB p65 subunit was compared between women with and without adenomyosis. Results The immunoreactivities of both the nuclear and the cytoplasmic NF-κB p65 subunit were significantly increased in the stromal cells in the eutopic endometrium as well as in the adenomyosis nodule of women with adenomyosis compared with controls, respectively. The nuclear expression of NF-κB p65 subunit was significantly higher in the glandular cells in the eutopic endometrium as well as the adenomyosis nodule of women with adenomyosis compared with controls, respectively. Conclusion The expression of NF-κB p65 is increased in the eutopic endometrium and adenomyosis nodule of women with adenomyosis, which strongly suggest that NF-κB plays a critical role in the pathogenesis and/or pathophysiology of adenomyosis.
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Wang F, Shi X, Qin X, Wen Z, Zhao X, Li C. Expression of CD56 in patients with adenomyosis and its correlation with dysmenorrhea. Eur J Obstet Gynecol Reprod Biol 2015; 194:101-5. [DOI: 10.1016/j.ejogrb.2015.08.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 08/05/2015] [Accepted: 08/17/2015] [Indexed: 11/30/2022]
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Yazbeck C, Falcone S, Ballout A, Gauché-Cazalis C, Epelboin S, Patrat C, Luton D. [An update on adenomyosis and implantation]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2015; 43:665-669. [PMID: 26439871 DOI: 10.1016/j.gyobfe.2015.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 09/04/2015] [Indexed: 06/05/2023]
Abstract
Adenomyosis is an enigmatic disease whose impact on implantation and fertility outcome is still controversial. A negative effect on IVF outcome was already observed, but it is mainly explained by an increase in early spontaneous miscarriages. We reviewed scientific data in order to bring relevant information about adenomyosis and endometrial receptivity for patient counselling and to precise if screening of adenomyosis is indicated before IVF treatment.
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Affiliation(s)
- C Yazbeck
- Service de gynécologie obstétrique et médecine de la reproduction, CHU Bichat-Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France.
| | - S Falcone
- Service de gynécologie obstétrique et médecine de la reproduction, CHU Bichat-Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
| | - A Ballout
- Service de gynécologie obstétrique et médecine de la reproduction, CHU Bichat-Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
| | - C Gauché-Cazalis
- Service de gynécologie obstétrique et médecine de la reproduction, CHU Bichat-Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
| | - S Epelboin
- Service de gynécologie obstétrique et médecine de la reproduction, CHU Bichat-Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
| | - C Patrat
- Service de gynécologie obstétrique et médecine de la reproduction, CHU Bichat-Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
| | - D Luton
- Service de gynécologie obstétrique et médecine de la reproduction, CHU Bichat-Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
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Zhihong N, Yun F, Pinggui Z, Sulian Z, Zhang A. Cytokine Profiling in the Eutopic Endometrium of Adenomyosis During the Implantation Window After Ovarian Stimulation. Reprod Sci 2015; 23:124-33. [DOI: 10.1177/1933719115597761] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- N. Zhihong
- Department of Obstetrics and Gynecology, IVF Unit, Ruijin Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - F. Yun
- Department of Obstetrics and Gynecology, IVF Unit, Ruijin Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Z. Pinggui
- Department of Obstetrics and Gynecology, IVF Unit, Ruijin Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Z. Sulian
- Department of Obstetrics and Gynecology, IVF Unit, Ruijin Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Aijun Zhang
- Department of Obstetrics and Gynecology, IVF Unit, Ruijin Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
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Li Y, Zou S, Xia X, Zhang S. Human Adenomyosis Endometrium Stromal Cells Secreting More Nerve Growth Factor: Impact and Effect. Reprod Sci 2014; 22:1073-82. [PMID: 25519715 DOI: 10.1177/1933719114561559] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Abnormal expression of nerve growth factor (NGF) was found in adenomyosis (AM). We collected AM foci from patients and eutopic endometrium from non-AM controls. Endometrium stromal cells (ESCs) were cultured. Different levels of 17β-estradiol, tumor necrosis factor (TNF), CoCl2, and H2O2 were added to the culture system separately, then the expression level of NGF in ESCs was detected. After adding different levels of NGF, the proliferation and apoptosis of ESCs and aromatase expression were detected. We found that 17β-estradiol promoted NGF production in AM ESCs but not in control ESCs; TNF promoted NGF production in both AM and control ESCs; and CoCl2 inhibited NGF production in control ESCs, but had no effect in AM ESCs. Nerve growth factor promoted the proliferation and synthesis of aromatase in AM ESCs. In conclusion, locally increased estrogen levels and inflammation may cause increased NGF production in the uterus of patients with AM. Nerve growth factor stimulated the proliferation and increased aromatase expression of ESCs from AM foci, suggesting NGF might contribute to the pathology and etiology of AM.
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Affiliation(s)
- Yan Li
- Department of Gynaecology, Obstetrics and Gynaecology Hospital, Fudan University, Shanghai, China Reproductive Medicine Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shien Zou
- Department of Gynaecology, Obstetrics and Gynaecology Hospital, Fudan University, Shanghai, China
| | - Xian Xia
- Department of Gynaecology, Obstetrics and Gynaecology Hospital, Fudan University, Shanghai, China
| | - Shaofen Zhang
- Department of Gynaecology, Obstetrics and Gynaecology Hospital, Fudan University, Shanghai, China
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Lin XH, Liu ME, Xu HY, Chen XJ, Wang H, Tian S, Sheng JZ, Huang HF. Leptin down-regulates γ-ENaC expression: a novel mechanism involved in low endometrial receptivity. Fertil Steril 2014; 103:228-35.e3. [PMID: 25450293 DOI: 10.1016/j.fertnstert.2014.10.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 09/11/2014] [Accepted: 10/01/2014] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To examine epithelial Na(+) channel (ENaC) expression in endometrium of overweight/obese women with polycystic ovary syndrome (PCOS) during the window of implantation, and to explore the mechanism linking leptin-mediated reduction of γ-ENaC to low endometrial receptivity. DESIGN Controlled, prospective, clinical, experimental study. SETTING University-based infertility center. PATIENT(S) Blood and endometrium samples were collected from 12 control women and 12 overweight/obese PCOS patients. Pregnancy outcomes were obtained from 245 women with male-factor infertility (533 cycles) and 57 infertile women with PCOS (120 cycles) who underwent intrauterine insemination. INTERVENTION(S) Human endometrial biopsies. MAIN OUTCOME MEASURE(S) Expression of ENaC mRNA and protein in endometrium. RESULT(S) The expression of γ-ENaC decreased in the secretory phase endometrium of PCOS patients who showed increased serum leptin levels. In cultured endometrial cells (Ishikawa cells), leptin dose-dependently down-regulated the expression of γ-ENaC and reduced the JAr spheroid attachment rate, which could be blocked by knockdown of STAT3, a signal in the pathway of leptin receptor activation. The overweight/obese PCOS patients with increased serum leptin levels showed a significantly increased biochemical pregnancy rate, suggesting that high leptin might attenuate endometrial receptivity and increase very early pregnancy loss. CONCLUSION(S) High serum leptin may reduce endometrial receptivity by activating the STAT3 signal pathway and down-regulating γ-ENaC expression in the endometrium. These results provide valuable new insights into the molecular mechanisms linking abnormal ENaC gene expression to early pregnancy loss in overweight/obese PCOS patients.
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Affiliation(s)
- Xian-Hua Lin
- Key Laboratory of Reproductive Genetics, Ministry of Education, Zhejiang University, Hangzhou, People's Republic of China; Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University, Hangzhou, People's Republic of China
| | - Miao-E Liu
- Key Laboratory of Reproductive Genetics, Ministry of Education, Zhejiang University, Hangzhou, People's Republic of China; Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University, Hangzhou, People's Republic of China
| | - Hai-Yan Xu
- Key Laboratory of Reproductive Genetics, Ministry of Education, Zhejiang University, Hangzhou, People's Republic of China; Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University, Hangzhou, People's Republic of China
| | - Xue-Jun Chen
- Medical Reproductive Center, Enze Maternity Hospital, Taizhou, Zhejiang, People's Republic of China
| | - Hui Wang
- Medical Reproductive Center, Hangzhou First People's Hospital, Hangzhou, People's Republic of China
| | - Shen Tian
- Key Laboratory of Reproductive Genetics, Ministry of Education, Zhejiang University, Hangzhou, People's Republic of China; Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University, Hangzhou, People's Republic of China
| | - Jian-Zhong Sheng
- Key Laboratory of Reproductive Genetics, Ministry of Education, Zhejiang University, Hangzhou, People's Republic of China; Department of Pathology and Pathophysiology, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - He-Feng Huang
- Key Laboratory of Reproductive Genetics, Ministry of Education, Zhejiang University, Hangzhou, People's Republic of China; International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China; Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University, Hangzhou, People's Republic of China.
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Zhang X, Xu H, Huang X, Quinn M. Altered innervation of the fallopian tube in adenomyosis. J OBSTET GYNAECOL 2014; 35:319-20. [PMID: 25110915 DOI: 10.3109/01443615.2014.948396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- X Zhang
- Department of Obstetrics and Gynaecology, Women's Hospital, School of Medicine, Zhejiang University , Hangzhou , China
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Matsuo K, Cahoon SS, Gualtieri M, Scannell CA, Jung CE, Takano T, Paulson RJ, Muderspach LI, Roman LD. Significance of adenomyosis on tumor progression and survival outcome of endometrial cancer. Ann Surg Oncol 2014; 21:4246-55. [PMID: 25001096 DOI: 10.1245/s10434-014-3880-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND To examine the effects of adenomyosis on tumor progression and survival outcome of endometrial cancer patients. METHODS This is a retrospective study examining stage I-IV endometrial cancer patients who underwent hysterectomy-based surgical staging (n = 571), and endometrial hyperplasia patients who underwent hysterectomy (n = 213). Clinical demographics, histopathological factors, and survival outcomes were analyzed based on the presence or absence of adenomyosis. RESULTS Among the endometrial cancer cohort, adenomyosis was observed in 47.5 % of cases and was significantly associated with lower grade (grade 1-2 tumors, 81.2 vs. 73.3 %; p = 0.028), earlier stage (stage I disease, 74.8 vs. 64.3 %; p = 0.023), and lower likelihood of deep myometrial invasion (19.2 vs. 28.2 %; p = 0.039) and cervical invasion (13.7 vs. 21.2 %; p = 0.024) than those without adenomyosis. In survival analysis, endometrial cancer coexisting with adenomyosis was associated with a significantly better disease-free survival (5-year rate, 89.2 vs. 78.2 %; p < 0.001) and overall survival (91.8 vs. 83.9 %; p = 0.004) after hysterectomy. In multivariate analysis, controlling for other significant variables in univariate analysis, presence of adenomyosis remained an independent prognostic factor associated with decreased risk of disease recurrence after surgery (hazard ratio [HR] 0.53; 95 % confidence interval [CI] 0.30-0.92; p = 0.023). Endometrial hyperplasia had a significantly increased incidence of adenomyosis when compared with type I endometrial cancer (grade 1-2 endometrioid adenocarcinoma, n = 411) on multivariate analysis (62.9 vs. 48.9 %; HR 1.88; 95 % CI 1.32-2.69; p < 0.001). CONCLUSIONS Adenomyosis appears to be associated with less aggressive tumor behavior of endometrial cancer, suggesting that it may have inhibitory effects on the progression of this disease.
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Affiliation(s)
- Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, Los Angeles, CA, USA,
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Benagiano G, Brosens I, Habiba M. Structural and molecular features of the endomyometrium in endometriosis and adenomyosis. Hum Reprod Update 2013; 20:386-402. [DOI: 10.1093/humupd/dmt052] [Citation(s) in RCA: 155] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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Kitaya K, Yasuo T. Regulatory role of membrane-bound form interleukin-15 on human uterine microvascular endothelial cells in circulating CD16(-) natural killer cell extravasation into human endometrium. Biol Reprod 2013; 89:70. [PMID: 23904514 DOI: 10.1095/biolreprod.113.111138] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Interleukin (IL)-15 plays a major role in accumulation of unique CD16(-) natural killer (NK) cells in the human endometrium, partly via selective extravasation of peripheral blood (PB) counterparts from local microvascular circulation. While IL-15 exhibits a chemotactic activity for PB CD16(-) NK cells, IL-15 attenuates their binding capacity to dermatan sulfate, the major CD62L ligand expressed on human uterine microvascular endothelial cells (HUtMVECs). These findings suggest that premature action of IL-15 interferes with CD62L-dependent tethering/rolling of PB CD16(-) NK cells on HUtMVECs, which is an early critical process of leukocyte extravasation. In this study, we investigated the mechanisms underlying the IL-15 regulation in the initial CD62L-dependent contact between PB CD16(-) NK cells and HUtMVECs. Unlike other candidate molecules, recombinant IL-15 downregulated CD62L expression on freshly isolated PB CD16(-) NK cells. IL-12 and IL-10, the two known upregulators of CD62L on CD16(-) NK cells, were not detectable in HUtMVECs and endometrial perivascular stromal cells. Binding to immobilized dermatan sulfate increased surface IL-15 receptor-alpha chain expression on CD16(-) NK cells. Under ovarian steroid stimulation, IL-15 was detectable on the surface, but not in the supernatant, of cultured HUtMVECs. Ovarian steroid-induced IL-15 expression on HUtMVECs was not attenuated by chondroitinase ABC (which degrades chondroitin sulfate-A and -C and dermatan sulfate) or sodium acetate buffer (which dissociates cytokines from their cognate receptors). These results suggest that HUtMVECs secrete a less soluble form of IL-15 into local microcirculation. Instead, HUtMVECs bear a membrane-bound form IL-15 under the influence of ovarian steroids, which may be favorable for preventing downregulation of CD62L on PB CD16(-) NK cells and facilitating their initial contact with HUtMVECs.
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Affiliation(s)
- Kotaro Kitaya
- Department of Anatomy and Cell Science, Kansai Medical University, Moriguchi, Osaka, Japan
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Li B, Chen M, Liu X, Guo SW. Constitutive and tumor necrosis factor-α-induced activation of nuclear factor-κB in adenomyosis and its inhibition by andrographolide. Fertil Steril 2013; 100:568-77. [PMID: 23706331 DOI: 10.1016/j.fertnstert.2013.04.028] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 04/03/2013] [Accepted: 04/15/2013] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate the action of nuclear factor (NF)-κB in adenomyosis and evaluate the potential therapeutic effect of andrographolide on tumor necrosis factor (TNF)-α-induced expression of NF-κB-mediated genes cyclooxygease-2 (COX-2), vascular endothelial growth factor (VEGF), and tissue factor (TF) in adenomyotic stromal cells. DESIGN Laboratory study using human tissues. SETTING Academic hospital. PATIENT(S) Twenty-nine patients (cases) with histologically confirmed adenomyosis and 14 (controls) without adenomyosis or endometriosis. INTERVENTION(S) Endometrial stromal cells derived from tissue samples harvested from both cases and controls were subjected to electrophoretic mobility shift assay, and gene and protein expression analyses. MAIN OUTCOME MEASURE(S) The NF-κB DNA-binding activity and protein levels of NF-κB subunits p50 and p65 and the messenger RNA (mRNA) and protein levels of NF-κB-mediated genes COX-2, VEGF, and TF in cases and controls, and their changes after stimulation with TNF-α and treatment with andrographolide. RESULT(S) The constitutive NF-κB DNA-binding activity and protein expression levels of p50 and p65, and mRNA and protein levels of COX-2, VEGF, and TF in cases were significantly higher than that of controls. The binding activity level correlated positively with dysmenorrhea severity in cases. The TNF-α stimulation further increased the binding activity, and the mRNA and protein levels of COX-2, VEGF, and TF, but treatment with andrographolide significantly reduced them. CONCLUSION(S) NF-κB may be a pivotal transcription factor involved in the development of adenomyosis. Targeting NF-κB with inhibitors, like andrographolide, may hold promises of treating adenomyosis.
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Affiliation(s)
- Bin Li
- Shanghai Obstetrics and Gynecology Hospital, Fudan University, Shanghai, People's Republic of China
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KOIKE NATSUKI, TSUNEMI TAIHEI, UEKURI CHIHARU, AKASAKA JURIA, ITO FUMINORI, SHIGEMITSU AIKO, KOBAYASHI HIROSHI. Pathogenesis and malignant transformation of adenomyosis (Review). Oncol Rep 2012; 29:861-7. [DOI: 10.3892/or.2012.2184] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 10/02/2012] [Indexed: 11/06/2022] Open
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Expression and possible role of interleukin-10 receptors in patients with adenomyosis. Eur J Obstet Gynecol Reprod Biol 2012; 161:194-8. [DOI: 10.1016/j.ejogrb.2011.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 09/10/2011] [Accepted: 12/14/2011] [Indexed: 02/04/2023]
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Xu Z, Zhao F, Lin F, Chen J, Huang Y. Lipoxin A4 inhibits the development of endometriosis in mice: the role of anti-inflammation and anti-angiogenesis. Am J Reprod Immunol 2012; 67:491-7. [PMID: 22229383 DOI: 10.1111/j.1600-0897.2011.01101.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 12/13/2011] [Indexed: 11/27/2022] Open
Abstract
PROBLEM To evaluate the effects of the anti-inflammatory and anti-angiogenic roles of LXA4 on endometriosis in mice. METHOD OF STUDY Endometriosis was induced in 40 mice and separated into two groups. LXA4 group was administered by LXA4 for 3 weeks. The endometriotic lesions were counted, measured, and identified by pathology. The presence of a panel of pro-inflammatory factors was assessed by real-time RT-PCR, and enzyme-linked immunoassay, the mRNA, protein levels of matrix metalloproteinase (MMPs), and vascular endothelial growth factor (VEGF) were determined by real-time RT-PCR and immunohistochemistry; the activity of MMPs was evaluated by gelatin zymography. RESULTS Treatment with LXA4 significantly inhibited endometriotic lesion development (13.58 ± 4.01 mm(2) in LXA4 group and 23.20 ± 7.49 mm(2) , P = 0.0002), downregulated pro-inflammatory factors, suppressed the activity of MMP9, and reduced the VEGF levels associated with endometriosis in mice. CONCLUSION LXA4 may inhibit the progression of endometriosis possibly by anti-inflammation and anti-angiogenesis.
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Affiliation(s)
- Zhangye Xu
- Department of Obstetrics and Gynecology, 1st Affiliated Hospital, Wenzhou Medical College, Zhejiang, China
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Abstract
Classically, the diagnosis of adenomyosis has only been possible on a hysterectomy specimen, usually in women in their late fourth and fifth decades, and, therefore, evaluating any relationship with infertility was simply not possible. As a consequence, to this day, no epidemiologic data exists linking adenomyosis to a state of subfertility. Today, new imaging techniques have enabled a noninvasive diagnosis at a much earlier time and a number of single-case or small series reports have appeared showing that medical, surgical, or combined treatment can restore fertility in women with adenomyosis, an indirect proof of an association. At the functional level, several anomalies found in the so-called junctional zone, or inner myometrium, in adenomyosis patients have been shown to be associated with poor reproductive performance, mainly through perturbed uterine peristalsis. Additional evidence for an association comes from experimental data: in baboons, adenomyosis is associated with lifelong primary infertility, as well as to endometriosis. Finally, indirect proof comes from studies of the eutopic and ectopic endometrium in women with adenomyosis proving the existence of an altered endometrial function and receptivity. In conclusion, sufficient indirect proof exists linking adenomyosis to infertility to warrant systematic clinical studies.
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Campo S, Campo V, Benagiano G. Adenomyosis and infertility. Reprod Biomed Online 2011; 24:35-46. [PMID: 22116070 DOI: 10.1016/j.rbmo.2011.10.003] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 09/30/2011] [Accepted: 10/04/2011] [Indexed: 12/19/2022]
Abstract
Today an accurate diagnosis of adenomyosis can be made thanks to progress in imaging techniques: sonography and magnetic resonance imaging (MRI). This has made it possible to clinically correlate the presence of adenomyosis to infertility. At the same time, a series of pathogenetic hypotheses have been presented to explain this correlation. First, the identification of the myometrial junctional zone (JZ) and of its disruption and thickening has been linked to poor reproductive performance mainly through perturbed uterine peristalsis, a phenomenon that originates exclusively from the JZ in the nonpregnant uterus. In addition, a number of biochemical and functional alterations in both eutopic and heterotopic endometrium in women with adenomyosis have now been found to lead to lower receptivity, indicated by the presence of 'implantation marker' defects. In these patients there is also an altered decidualization and abnormal concentrations of intrauterine free radicals. All these abnormalities in the endometrial environment seem to contribute to subfertility. Several attempts have been made to restore fertility in adenomyosis patients, the oldest being gonadotrophin-releasing hormone agonists coupled to conservative surgery. Also, uterine artery embolization and MRI-assisted high-intensity focused ultrasound ablation have been tried with some degree of success.
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Affiliation(s)
- Sebastiano Campo
- Institute of Obstetrics and Gynaecology, Catholic University of Sacred Heart, Rome, Italy
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42
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Li Y, Zhang SF, Zou SE, Xia X, Bao L. Accumulation of nerve growth factor and its receptors in the uterus and dorsal root ganglia in a mouse model of adenomyosis. Reprod Biol Endocrinol 2011; 9:30. [PMID: 21385399 PMCID: PMC3062588 DOI: 10.1186/1477-7827-9-30] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 03/08/2011] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Adenomyosis is a common gynecological disease, which is accompanied by a series of immunological and neuroendocrinological changes. Nerve growth factor (NGF) plays a critical role in producing pain, neural plasticity, immunocyte aggregation and release of inflammatory factors. This study aimed to investigate the expression of NGF and its two receptors in uteri and dorsal root ganglia (DRG) in an adenomyosis mouse model, as well as their relationship with the severity of adenomyosis. METHODS Forty newborn ICR mice were randomly divided into the adenomyosis model group and control group (n = 20 in each group). Mice in the adenomyosis model group were orally dosed with 2.7 μmol/kg tamoxifen on days 2-5 after birth. Experiments were conducted to identify the expression of NGF- beta and its receptors, tyrosine kinase receptor (trkA) and p75 neurotrophin receptor (p75NTR), in the uterus and DRG in four age groups (90+/-5 d, 140+/-5 d, 190+/-5 d and 240+/-5 d; n = 5 mice in each group) by western bolt, immunochemistry and real time reverse transcription-polymerase chain reaction. RESULTS Adenomyosis, which became more serious as age increased, was successfully induced in dosed ICR mice. NGF-beta, trkA and p75NTR protein levels in the uterus and trkA mRNA levels in DRG were higher in the older aged adenomyosis model group than those in controls (190+/-5 d and 240+/-5 d groups, P < 0.05). The expression of NGF-beta and its receptors in the uterus increased gradually as age increased for adenomyosis mice (190+/-5 d and 240+/-5 d, P < 0.05, compared with 90+/-5 d) but it showed little change in control mice. The mRNA level of trkA in DRG also increased as age increased in the adenomyosis model group (190+/-5 d and 240+/-5 d, P < 0.05, compared with 90+/-5 d) but was unchanged in controls. The mRNA level of p75NTR in DRG was not different between the adenomyosis and control groups and was stable from young to old mice. CONCLUSIONS NGF- beta can be used as an indicator for the severity of adenomyosis. The gradually increasing level of NGF- beta and its receptors while the disease becomes more severe suggests an effect of NGF- beta on pathogenic mechanisms of adenomyosis.
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Affiliation(s)
- Yan Li
- Department of Gynaecology, Obstetrics and Gynaecology Hospital, Fudan University, Shanghai, 200011, PR China
- Reproductive medicine center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, PR China
| | - Shao-fen Zhang
- Department of Gynaecology, Obstetrics and Gynaecology Hospital, Fudan University, Shanghai, 200011, PR China
| | - Shi-en Zou
- Department of Gynaecology, Obstetrics and Gynaecology Hospital, Fudan University, Shanghai, 200011, PR China
| | - Xian Xia
- Department of Gynaecology, Obstetrics and Gynaecology Hospital, Fudan University, Shanghai, 200011, PR China
| | - Lei Bao
- Department of Gynaecology, Obstetrics and Gynaecology Hospital, Fudan University, Shanghai, 200011, PR China
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Kim SR, Kim SH, Lee HW, Chae HD, Kim CH, Kang BM. Increased expression of p21-activated kinase in adenomyosis. Fertil Steril 2010; 94:1125-8. [DOI: 10.1016/j.fertnstert.2009.11.048] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Revised: 11/12/2009] [Accepted: 11/19/2009] [Indexed: 10/19/2022]
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Nie J, Lu Y, Liu X, Guo SW. Immunoreactivity of progesterone receptor isoform B, nuclear factor κB, and IκBα in adenomyosis. Fertil Steril 2009; 92:886-889. [DOI: 10.1016/j.fertnstert.2009.01.084] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2008] [Revised: 01/13/2009] [Accepted: 01/16/2009] [Indexed: 01/31/2023]
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