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Wardhana MP, Kuntaman K, Utomo B, Aryananda RA, Rifdah SN, Wafa IA, Shahnaz AA, Ningrum D, Cininta NI, Ariani G, Van Lith JM, Dachlan EG. Evidence of Placental Villous Inflammation and Apoptosis in Third-Trimester Symptomatic SARS-CoV-2 Maternal Infection. Yonsei Med J 2024; 65:202-209. [PMID: 38515357 PMCID: PMC10973560 DOI: 10.3349/ymj.2023.0309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/03/2023] [Accepted: 10/30/2023] [Indexed: 03/23/2024] Open
Abstract
PURPOSE In view of conflicting reports on the ability of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) to infect placental tissue, this study aimed to further evaluate the impact of inflammation and placental damage from symptomatic third-trimester maternal COVID-19 infection. MATERIALS AND METHODS This case-control study included 32 placenta samples each from symptomatic COVID-19 pregnancy and normal non-COVID-19 pregnancy. The villous placental area's inflammatory expression [angiotensin converting enzyme-2 (ACE-2), transmembrane protease serine-2 (TMPRSS2), interferon-γ (IFN-γ), interleukin-6 (IL-6), and SARS-CoV-2 spike protein] and apoptotic rate were examined using immunohistochemistry and Terminal deoxynucleotidyl transferase dUTP Nick-End Labeling (TUNEL) assay. Comparison and correlation analysis were used based on COVID-19 infection, placental SARS-CoV-2 spike protein evidence, and maternal severity status. RESULTS Higher expressions of TMPRSS2, IFN-γ, and trophoblast apoptotic rate were observed in the COVID-19 group (p<0.001), whereas ACE-2 and IL-6 expressions were not significantly different from the control group (p>0.05). Additionally, SARS-CoV-2 spike protein was detected in 8 (25%) placental samples of COVID-19 pregnancy. COVID-19 subgroup analysis revealed increased IFN-γ, trophoblast, and stromal apoptosis (p<0.01). Moreover, the results of the current study revealed no correlation between maternal COVID-19 severity and placental inflammation as well as the apoptotic process. CONCLUSION The presence of SARS-CoV-2 spike protein as well as altered inflammatory and apoptotic processes may indicate the presence of placental disturbance in third-trimester maternal COVID-19 infection. The lack of correlation between placental disruption and maternal severity status suggests the need for more research to understand the infection process and any potential long-term impacts on all offsprings born to COVID-19-infected pregnant women.
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Affiliation(s)
- Manggala Pasca Wardhana
- Doctoral Program of Medical Science, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Academic General Hospital, Surabaya, Indonesia
| | - Kuntaman Kuntaman
- Doctoral Program of Medical Science, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Clinical Microbiology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Budi Utomo
- Doctoral Program of Medical Science, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Public Health, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Rozi Aditya Aryananda
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Academic General Hospital, Surabaya, Indonesia
| | | | - Ifan Ali Wafa
- Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Almira Aulia Shahnaz
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Academic General Hospital, Surabaya, Indonesia
| | - Dahlia Ningrum
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Academic General Hospital, Surabaya, Indonesia
| | - Nareswari Imanadha Cininta
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Academic General Hospital, Surabaya, Indonesia
| | - Grace Ariani
- Anatomical Pathology Department, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Academic General Hospital, Surabaya, Indonesia
| | - Jan Mm Van Lith
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Academic General Hospital, Surabaya, Indonesia
- Department of Gynaecology and Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Erry Gumilar Dachlan
- Doctoral Program of Medical Science, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Academic General Hospital, Surabaya, Indonesia.
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Novel DNA Damage-Related Subtypes Characterization Identifies Uterine Corpus Endometrial Carcinoma (UCEC) Based on Machine Learning. JOURNAL OF ONCOLOGY 2022; 2022:3588117. [PMID: 36072975 PMCID: PMC9441400 DOI: 10.1155/2022/3588117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 11/17/2022]
Abstract
Objective. Accumulating evidence suggests that DNA damage is associated with numerous gynecological illnesses, particularly advanced uterine corpus endometrial carcinoma (UCEC), illustrating the involvement of the DNA damage pathway in the advancement of UCEC. This research aimed to discover a robust subtype with the potential to contribute to the scientific treatment of UCEC. Methods. In this work, the expression patterns of prognostic DNA damage-related genes were curated, and consensus clustering analyses were undertaken to determine DNA damage subtypes in patients with UCEC in the TCGA cohort. Two DNA damage-related subtypes were identified for further investigation. Differentially expressed genes (DEGs) analysis, gene ontology analysis, mutation analysis, and immune cell infraction analysis were performed to find the molecular mechanism behind it. Finally, the polymerase chain reaction (PCR) was conducted to verify the correlation of the hub genes. Results. In total, 545 patients with UCEC were tested for two distinct DNA damage subtypes. The clinical prognosis was poorer among patients with DNA damage subtype 2 than those in subtype 1. The DEGs analysis and PPI analysis showed that ASMP, BUB1, CENPF, MAD2L1, NCAPG, SGO2, and TOP2A were expressed higher in UCEC tissues than in the normal tissues. Immune cell infraction analysis showed that hub genes were associated with the tumor microenvironment (TME). Conclusion. Altogether, our research identified two distinct DNA damage subtypes that are complicated and heterogeneous. A better knowledge of the characteristics of the TME may be gained by quantitative measurement of DNA damage subtypes in individual patients, which can also lead to the development of more successful treatment regimens.
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Eid BG. Chrysin attenuates estradiol-induced endometrial hyperplasia in rats via enhancing PPARα activity. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:54273-54281. [PMID: 35301625 DOI: 10.1007/s11356-022-19206-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/09/2022] [Indexed: 06/14/2023]
Abstract
Endometrial hyperplasia (EH) is a complex condition that commonly affects women after menopause. Since the current available treatments for EH are mainly invasive, there is a need for developing new treatment modalities. Chrysin (Ch) is a dihydroxyflavone with numerous promising therapeutic potentials. In this study, Ch's protective effects on estradiol (E2)-induced EH were studied in rats. Animals were allocated randomly to five groups and were treated for 4 weeks as follows: Group 1, control: received the vehicle; group 2, Ch: received Ch 25 mg/kg; group 3, estradiol (E2): received E2 (3 mg/kg) 3 × weekly subcutaneously and the vehicle. Group 4, E2 + Ch 10 mg/kg and group 5, E2 + Ch 25 mg/kg: Ch was given once daily at 10 mg/kg or 25 mg/kg, respectively. In addition, E2 was administered 3 × weekly (3 mg/kg) in groups 4 and 5. Ch inhibited the E2-induced increase in uterine weights and histopathological changes. Ch lowered the cyclin D1 expression. Ch raised the caspase-3 content and Bax mRNA expression. Furthermore, it corrected the raised Bcl2 mRNA expression due to E2. Ch inhibited MDA accumulation and GSH depletion. It also prevents E2-induced SOD and GPx exhaustion. It also ameliorated the rise in NFκB, TNF-α, and IL-6 expression. These effects were correlated with an enhanced PPARα activity ratio relative to the E2 group. This suggests that Ch attenuates EH in this model by exerting anti-proliferative, anti-oxidant, and anti-inflammatory effects partially through increasing PPARα activity.
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Affiliation(s)
- Basma Ghazi Eid
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, King Abdulaziz University, Jeddah, 21589, Saudi Arabia.
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Bi JT, Bai RJ, Zhan HL, Qian ZH, Gong LH, Liu YQ, Zheng ZX, Cai X. Excessive proliferation and apoptosis of parathyroid cells contribute to primary hyperparathyroidism in rabbit model. J Investig Med 2022; 70:1392-1398. [DOI: 10.1136/jim-2021-002184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2022] [Indexed: 11/03/2022]
Abstract
To explore the molecular pathogenesis of primary hyperparathyroidism (PHPT), we investigated the proliferation and apoptosis of parathyroid cells in a rabbit model of diet-induced PHPT. A total of 120 adult Chinese rabbits were randomly divided into normal diet (Ca:P, 1:0.7) group (control group) or a high-phosphate diet (Ca:P, 1:7) group (experimental group). The thyroid and parathyroid complexes were harvested for 1-month interval from month 1 to month 6. The expression of proliferation markers, including proliferating cell nuclear antigen (PCNA) and cyclin-D1, and B cell lymphoma-2 (Bcl-2), were evaluated by immunohistochemistry in thyroid and parathyroid tissues. Apoptosis was quantified by DNA-fragment terminal labeling. Our results demonstrated that parathyroid cells in the experimental group started proliferating from the end of the 2nd month, the expression of PCNA, Bcl-2, and cyclin-D1 were significantly higher in the PHPT group than those of the control group (p<0.05). Furthermore, the apoptosis index (AI) was positively correlated with the glandular cell count and expression of PCNA in the 6th month in the PHPT group. Overall, our results suggested that excessive proliferation and apoptosis of parathyroid cells may contribute to the pathogenesis of PHPT through PCNA-related, Bcl-2-related, and cyclin-D1-related pathways.
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Jetley S, Walvir N, Rana S, Jairajpuri Z, Nigam A. A histopathological and immunohistochemistry analysis of endometrial lesions among women presenting with abnormal uterine bleeding. J Cancer Res Ther 2022; 18:1474-1484. [DOI: 10.4103/jcrt.jcrt_915_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Kosmas Konstantinos, Georgia M, Marios S, Eirini K, Anna M. Expression of Bcl-2 in Imprint Smears of Endometrial Carcinoma. CYTOL GENET+ 2020. [DOI: 10.3103/s0095452720040064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chandran JR. RETRACTED ARTICLE: Advances in Diagnosis of Endometrial Hyperplasia. J Obstet Gynaecol India 2019; 69:204. [PMID: 31686758 PMCID: PMC6801245 DOI: 10.1007/s13224-018-1111-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/12/2018] [Indexed: 11/26/2022] Open
Affiliation(s)
- Jyoti Ramesh Chandran
- Obstetrics and Gynaecology, Institute of Maternal and Child Health, Government Medical College Kozhikode, Kozhikode, Kerala 673008 India
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Travaglino A, Raffone A, Saccone G, Insabato L, Mollo A, De Placido G, Zullo F. Loss of B-cell lymphoma 2 immunohistochemical expression in endometrial hyperplasia: A specific marker of precancer and novel indication for treatment. Acta Obstet Gynecol Scand 2018; 97:1415-1426. [DOI: 10.1111/aogs.13452] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/22/2018] [Accepted: 08/25/2018] [Indexed: 01/15/2023]
Affiliation(s)
- Antonio Travaglino
- Department of Advanced Biomedical Sciences, School of Medicine; University of Naples Federico II; Naples Italy
| | - Antonio Raffone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine; University of Naples Federico II; Naples Italy
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine; University of Naples Federico II; Naples Italy
| | - Luigi Insabato
- Department of Advanced Biomedical Sciences, School of Medicine; University of Naples Federico II; Naples Italy
| | - Antonio Mollo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine; University of Naples Federico II; Naples Italy
| | - Giuseppe De Placido
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine; University of Naples Federico II; Naples Italy
| | - Fulvio Zullo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine; University of Naples Federico II; Naples Italy
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Reusche N, Beineke A, Urhausen C, Beyerbach M, Schmicke M, Kramer S, Günzel-Apel A. Proliferative and apoptotic changes in the healthy canine endometrium and in cystic endometrial hyperplasia. Theriogenology 2018; 114:14-24. [DOI: 10.1016/j.theriogenology.2018.03.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 03/02/2018] [Accepted: 03/13/2018] [Indexed: 10/17/2022]
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Sanderson PA, Critchley HO, Williams AR, Arends MJ, Saunders PT. New concepts for an old problem: the diagnosis of endometrial hyperplasia. Hum Reprod Update 2017; 23:232-254. [PMID: 27920066 PMCID: PMC5850217 DOI: 10.1093/humupd/dmw042] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 10/24/2016] [Accepted: 10/31/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Endometrial hyperplasia (EH) is a uterine pathology representing a spectrum of morphological endometrial alterations. It is predominantly characterized by an increase in the endometrial gland-to-stroma ratio when compared to normal proliferative endometrium. The clinical significance of EH lies in the associated risk of progression to endometrioid endometrial cancer (EC) and 'atypical' forms of EH are regarded as premalignant lesions. Traditional histopathological classification systems for EH exhibit wide and varying degrees of diagnostic reproducibility and, as a consequence, standardized patient management can be challenging. OBJECTIVE AND RATIONALE EC is the most common gynaecological malignancy in developed countries. The incidence of EC is rising, with alarming increases described in the 40-44-year-old age group. This review appraises the current EH classification systems used to stratify women at risk of malignant progression to EC. In addition, we summarize the evidence base regarding the use of immunohistochemical biomarkers for EH and discuss an emerging role for genomic analysis. SEARCH METHODS PubMed, Medline and the Cochrane Database were searched for original peer-reviewed primary and review articles, from January 2000 to January 2016. The following search terms were used: 'endometrial hyperplasia', 'endometrial intraepithelial neoplasia', 'atypical hyperplasia', 'complex atypical hyperplasia', 'biomarker', 'immunohistochemistry', 'progression', 'genomic', 'classification' and 'stratification'. OUTCOMES Recent changes to EH classification reflect our current understanding of the genesis of endometrioid ECs. The concept of endometrial intraepithelial neoplasia (EIN) as a mutationally activated, monoclonal pre-malignancy represents a fundamental shift from the previously held notion that unopposed oestrogenic stimulation causes ever-increasing hyperplastic proliferation, with accumulating cytological atypia that imperceptibly leads to the development of endometrioid EC. Our review highlights several key biomarker candidates that have been described as both diagnostic tools for EH and markers of progression to EC. We propose that, moving forwards, a 'panel' approach of combinations of the immunohistochemical biomarkers described in this review may be more informative since no single candidate can currently fill the entire role. WIDER IMPLICATIONS EC has historically been considered a predominantly postmenopausal disease. Owing in part to the current unprecedented rates of obesity, we are starting to see signs of a shift towards a rising incidence of EC amongst pre- and peri-menopausal woman. This creates unique challenges both diagnostically and therapeutically. Furthering our understanding of the premalignant stages of EC development will allow us to pursue earlier diagnosis and facilitate appropriate stratification of women at risk of developing EC, permitting timely and appropriate therapeutic interventions.
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Affiliation(s)
- Peter A. Sanderson
- MRC Centre for Inflammation Research, The University of Edinburgh, The Queen's Medical Research Institute, 47 Little France Crescent, EdinburghEH16 4TJ, UK
| | - Hilary O.D. Critchley
- MRC Centre for Reproductive Health, The University of Edinburgh, The Queen's Medical Research Institute, 47 Little France Crescent, EdinburghEH16 4TJ, UK
| | - Alistair R.W. Williams
- Division of Pathology, The Royal Infirmary of Edinburgh, 51 Little France Crescent, EdinburghEH16 4SA, UK
| | - Mark J. Arends
- Division of Pathology, Edinburgh Cancer Research Centre, Western General Hospital, Crewe Road South, EdinburghEH4 2XR, UK
- Centre for Comparative Pathology, The University of Edinburgh, Easter Bush, MidlothianEH25 9RG, UK
| | - Philippa T.K. Saunders
- MRC Centre for Inflammation Research, The University of Edinburgh, The Queen's Medical Research Institute, 47 Little France Crescent, EdinburghEH16 4TJ, UK
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Bozkurt KK, Yalçın Y, Erdemoğlu E, Tatar B, Erdemoğlu E, Çerçi SS, Çiriş İM, Başpınar Ş, Uğuz A, Kapucuoğlu N. The role of immunohistochemical adrenomedullin and Bcl-2 expression in development of type-1 endometrial adenocarcinoma: Adrenomedullin expression in endometrium. Pathol Res Pract 2016; 212:450-5. [PMID: 26972419 DOI: 10.1016/j.prp.2016.02.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 02/02/2016] [Accepted: 02/24/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Adrenomedullin (AM) is a pluripotent peptide first discovered from human pheochromocytoma. AM expression has been shown in various cancer types including endometrium cancer. Bcl-2 is an antiapoptotic protein which might be regulated by AM in hypoxic conditions. The aim of the present study was to investigate the role of AM and Bcl-2 expressions in carcinogenesis of type-1 endometrium cancer. MATERIALS AND METHOD Study group consisted of 10 proliferative endometrium, 22 simple endometrial hyperplasia, 23 endometrial intraepithelial neoplasia (EIN) and 30 Grade 1 endometrioid adenocarcinoma patients. AM and Bcl-2 expressions were investigated by immunohistochemistry. RESULTS Mean AM Allred score was 3±2.6, 5.6±1.6 and 5.7±2.5 in benign, EIN and adenocarcinoma groups, respectively. AM expression was significantly higher in EIN and adenocarcinoma groups than in benign endometrium group (p<0.05). Mean Bcl-2 Allred score was 6.4±2.1, 5.2±2.6, 2.3±2 in benign endometrium, EIN and adenocarcinoma groups, respectively. Mean Bcl-2 Allred score was similar between benign endometrium and EIN groups (p>0.05). However, it was significantly lower in adenocarcinoma group (p<0.05). An inverse correlation between AM and Bcl-2 expressions was found (r: -0.4, p<0.001). CONCLUSIONS Our findings showed that AM expression increased in progression from benign endometrium to EIN and type-1 adenocarcinoma while expression of Bcl-2 decreased in transition from EIN to carcinoma.
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Affiliation(s)
- Kemal Kürşat Bozkurt
- Süleyman Demirel University, Faculty of Medicine, Department of Pathology, Isparta, Turkey.
| | - Yakup Yalçın
- Suleyman Demirel University, Faculty of Medicine, Department of Gynecologic Oncology, Isparta, Turkey.
| | - Ebru Erdemoğlu
- Isparta Maternity Hospital, Department of Obstetrics and Gynecology, Isparta, Turkey.
| | - Burak Tatar
- Suleyman Demirel University, Faculty of Medicine, Department of Gynecologic Oncology, Isparta, Turkey.
| | - Evrim Erdemoğlu
- Suleyman Demirel University, Faculty of Medicine, Department of Gynecologic Oncology, Isparta, Turkey.
| | - Sevim Süreyya Çerçi
- Suleyman Demirel University, Faculty of Medicine, Department of Nuclear Medicine, Isparta, Turkey.
| | - İbrahim Metin Çiriş
- Süleyman Demirel University, Faculty of Medicine, Department of Pathology, Isparta, Turkey.
| | - Şirin Başpınar
- Süleyman Demirel University, Faculty of Medicine, Department of Pathology, Isparta, Turkey.
| | - Afife Uğuz
- Süleyman Demirel University, Faculty of Medicine, Department of Pathology, Isparta, Turkey.
| | - Nilgün Kapucuoğlu
- Acıbadem Maslak Hospital, Department of Pathology, Istanbul, Turkey.
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Laban M, Ibrahim EAS, Agur W, Elddin Ahmed AMB. Bcl-2 may play a role in the progression of endometrial hyperplasia and early carcinogenesis, but not linked to further tumorigenesis ☆. J Microsc Ultrastruct 2014; 3:19-24. [PMID: 30023177 PMCID: PMC6014220 DOI: 10.1016/j.jmau.2014.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Revised: 10/16/2014] [Accepted: 11/06/2014] [Indexed: 11/17/2022] Open
Abstract
The role of Bcl-2 in initiation and progression of endometrial carcinoma is still with inconsistent results. The aim of this study is to determine the role of Bcl-2 in endometrial tumorigenesis. It is a retrospective cross sectional study. We used 100 endometrial paraffin embedded specimens for Bcl-2 oncoprotein immunohistochemical staining; 20 samples of normal endometrium, 40 specimens of endometrial hyperplasia (simple, complex and atypical) and 40 specimens of endometrioid adenocarcinoma. The results were statistically analyzed. There was a significant increase in Bcl-2 staining from normal through complex and atypical hyperplasia into well differentiated adenocarcinoma (P =0.002, P =0.0008 and P =0.0001, respectively). There was a significant difference between the staining of different types of endometrial hyperplasia; as it up streamed from the simple through the complex up to the atypical types (P <0.05). Bcl-2 staining showed no significant correlation with the moderately, poorly differentiated and the different stages of adenocarcinoma (P =0.6, P =0.29 and P =0.1 respectively). These results might indicate a substantial role for Bcl-2 as one of the initiating drives for endometrial tumorigenesis, but not in further tumor progression.
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Affiliation(s)
- Mohamed Laban
- Department of Obstetrics & Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Wael Agur
- Department of Obstetrics & Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.,Department of Obstetrics & Gynecology, NHS Ayrshire & Arran, NHS Research Scotland, UK
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Płuciennik E, Kośla K, Wójcik-Krowiranda K, Bieńkiewicz A, Bednarek AK. The WWOX tumor suppressor gene in endometrial adenocarcinoma. Int J Mol Med 2013; 32:1458-64. [PMID: 24126431 DOI: 10.3892/ijmm.2013.1526] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 10/02/2013] [Indexed: 11/05/2022] Open
Abstract
Endometrial cancer is a lethal malignancy, the causes of which remain to be determined. The aim of the present study, carried out on tumor samples from 79 patients, was to evaluate the role of the WWOX tumor suppressor gene in endometrial adenocarcinoma. The expression levels of WWOX and its protein content were assessed in normal endometrium and cancer samples. Quantitative PCR was used to assess the correlation between the expression levels of WWOX and the genes involved in the proliferation (MKI67), apoptosis (BAX, BCL2), signal transduction (EGFR), cell cycle (CCNE1, CCND1), cell adhesion (CDH1) and transcription regulation (TP73, NCOR1). The relationship between loss of hetero-zygosity (LOH) and WWOX mRNA levels was also investigated using high resolution melting. Results of the present study demonstrated a positive correlation of WWOX expression with BCL2 and CCND1 and a negative correlation with BAX, CDH1, NCOR1 and BCL2/BAX ratio. The results also showed that loss of heterozygosity at two analyzed loci of the WWOX gene is frequent in patients with endometrial cancer and that WWOX expression levels are lower in tumor samples than in normal tissue. In conclusion, WWOX may be involved in endometrial cancer.
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Affiliation(s)
- Elżbieta Płuciennik
- Department of Molecular Cancerogenesis, Medical University of Lodz, PL 90-752 Lodz, Poland
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Dorjgochoo T, Xiang YB, Long J, Shi J, Deming S, Xu WH, Cai H, Cheng J, Cai Q, Zheng W, Shu XO. Association of genetic markers in the BCL-2 family of apoptosis-related genes with endometrial cancer risk in a Chinese population. PLoS One 2013; 8:e60915. [PMID: 23637776 PMCID: PMC3634058 DOI: 10.1371/journal.pone.0060915] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 03/05/2013] [Indexed: 12/11/2022] Open
Abstract
Background In vitro studies have demonstrated the role of the BCL-2 family of genes in endometrial carcinogenesis. The role of genetic variants in BCL-2 genes and their interactions with non-genetic factors in the development of endometrial cancer has not been investigated in epidemiological studies. Patients and Methods We examined the relationship between BCL-2 gene family variants and endometrial cancer risk among 1,028 patients and 1,922 age-matched community controls from Shanghai, China. We also investigated possible interactions between genetic variants and established risk factors (demographic, lifestyle and clinical). Individuals were genotyped for 86 tagging single nucleotide polymorphisms (SNPs) in the BCL2, BAX, BAD and BAK1 genes. Results Significant associations with endometrial cancer risk were found for 9 SNPs in the BCL2 gene (P trend<0.05 for all). For SNPs rs17759659 and rs7243091 (minor allele for both: G), the associations were independent. The odds ratio was 1.27 (95% CI: 1.04–1.53) for women with AG genotype for the SNP rs17759659 and 1.82 (95% CI: 1.21–2.73) for women with the GG genotype for the SNP rs7243091. No interaction between these two SNPs and established non-genetic risk factors of endometrial cancer was noticed. Conclusion Genetic polymorphisms in the BCL2 gene may be associated with the risk of endometrial cancer in Chinese women.
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Affiliation(s)
- Tsogzolmaa Dorjgochoo
- Division of Epidemiology, Department of Medicine and Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Yong-Bing Xiang
- Department of Epidemiology, Shanghai Cancer Institute, Shanghai, China
| | - Jirong Long
- Division of Epidemiology, Department of Medicine and Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Jiajun Shi
- Division of Epidemiology, Department of Medicine and Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Sandra Deming
- Division of Epidemiology, Department of Medicine and Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Wang-Hong Xu
- Department of Epidemiology, Shanghai Cancer Institute, Shanghai, China
| | - Hui Cai
- Division of Epidemiology, Department of Medicine and Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Jiarong Cheng
- Department of Epidemiology, Shanghai Cancer Institute, Shanghai, China
| | - Qiuyin Cai
- Division of Epidemiology, Department of Medicine and Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine and Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Xiao-Ou Shu
- Division of Epidemiology, Department of Medicine and Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Vanderbilt University, Nashville, Tennessee, United States of America
- * E-mail:
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Upson K, Allison KH, Reed SD, Jordan CD, Newton KM, Swisher EM, Doherty JA, Garcia RL. Biomarkers of progestin therapy resistance and endometrial hyperplasia progression. Am J Obstet Gynecol 2012; 207:36.e1-8. [PMID: 22727345 DOI: 10.1016/j.ajog.2012.05.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 04/12/2012] [Accepted: 05/10/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We sought to identify biomarkers associated with progestin therapy resistance and persistence/progression of endometrial hyperplasia. STUDY DESIGN We performed a nested case-control study among women with complex (n = 73) and atypical (n = 41) hyperplasia treated with oral progestin, followed up 2-6 months for persistence/progression. We evaluated index endometrial protein expression for progesterone receptor isoform A, progesterone receptor isoform B (PRB), PTEN, Pax-2, and Bcl-2. Odds ratios and 95% confidence intervals (CIs) were estimated. RESULTS Among women with atypical hyperplasia, high PRB expression was associated with 90% decreased risk of persistence/progression (95% CI, 0.01-0.8). High expression of progesterone receptor A and PRB suggested decreased risk of persistence/progression (odds ratio, 0.1; 95% CI, 0.02-1.0). These findings were not observed among women with complex hyperplasia. No associations were found with PTEN, Pax-2, and Bcl-2 protein expression. CONCLUSION PRB expression shows promise as a biomarker of progestin response. Further research is warranted to understand how PRB expression may guide treatment decisions.
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Affiliation(s)
- Kristen Upson
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA.
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Cormio A, Guerra F, Cormio G, Pesce V, Fracasso F, Loizzi V, Resta L, Putignano G, Cantatore P, Selvaggi LE, Gadaleta MN. Mitochondrial DNA content and mass increase in progression from normal to hyperplastic to cancer endometrium. BMC Res Notes 2012; 5:279. [PMID: 22676897 PMCID: PMC3502111 DOI: 10.1186/1756-0500-5-279] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 06/07/2012] [Indexed: 12/31/2022] Open
Abstract
Background An increase in mitochondrial DNA (mtDNA) content and mitochondrial biogenesis associated with the activation of PGC-1α signalling pathway was previously reported in type I endometrial cancer. The aim of this study has been to evaluate if mtDNA content and the citrate synthase (CS) activity, an enzyme marker of mitochondrial mass, increase in progression from control endometrium to hyperplasia to type I endometrial carcinoma. Results Given that no statistically significant change in mtDNA content and CS activity in endometrium taken from different phases of the menstrual cycle or in menopause was found, these samples were used as control. Our research shows, for the first time, that mtDNA content and citrate synthase activity increase in hyperplastic endometrium compared to control tissues, even if their levels remain lower compared to cancer tissue. In particular, mtDNA content increases seem to precede increases in CS activity. No statistically significant change in mtDNA content and in CS activity was found in relation to different histopathological conditions such as grade, myometrial invasion and stage. Conclusion MtDNA content and citrate synthase activity increases in pre-malignant lesions could be a potential molecular marker for progression from hyperplasia to carcinoma.
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Affiliation(s)
- Antonella Cormio
- Department of Biosciences, Biotechnologies and Pharmacological Sciences, University of Bari, Via Orabona, Bari, 4-70126, Italy.
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17
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Aberrant bcl-2 deficiency in endometrial hyperplasia. Pathology 2011; 43:378-80. [PMID: 21566496 DOI: 10.1097/pat.0b013e3283468613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Immunohistochemical markers in endometrial hyperplasia: is there a panel with promise? A review. Appl Immunohistochem Mol Morphol 2008; 16:329-43. [PMID: 18528284 DOI: 10.1097/pai.0b013e318159b88e] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Despite advances in defining the biology of endometrial carcinomas, there has been little progress in determining markers that distinguish preinvasive endometrial proliferations. The goal of this literature review was to identify studies on endometrial hyperplasia (EH) that describe markers with potential to predict response to progestin therapy or potential for progression to invasive disease. METHODS Articles published between January 2000 and October 2006 were identified using the key words endometrial hyperplasia and progesterone receptor or estrogen receptor or biologic marker or immunohistochemistry/immunohistochemical. Articles that reported immunohistochemical studies on specimens of human EH +/-endometrioid endometrial carcinoma with a normal comparison group were included. Only those who reported hyperplasia with atypia separately from nonatypical hyperplasia and with a sample size greater than 10 specimens for the sum of complex and atypical samples were included. RESULTS A total of 289 abstracts were reviewed and 150 articles potentially met inclusion criteria. Of these, 123 described immunohistochemical studies on human EH specimens. Only 46 met all criteria for analysis of 61 different markers. CONCLUSIONS PTEN seems to have the greatest potential for diagnostic utility in EH, perhaps in combination with Bcl-2 and Bax. However, more uniform and rigorous studies are required to confirm these and additional markers' utility diagnostically in a diagnostic panel. As a major clinical priority is to determine which lesions can be treated medically and which require surgical intervention, focusing future studies on markers that distinguish response to hormone therapy or are involved in hormone regulation, will be important future considerations.
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Yu Z, Shah DM. Curcumin down-regulates Ets-1 and Bcl-2 expression in human endometrial carcinoma HEC-1-A cells. Gynecol Oncol 2007; 106:541-8. [PMID: 17590421 DOI: 10.1016/j.ygyno.2007.05.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2007] [Revised: 04/27/2007] [Accepted: 05/07/2007] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Curcumin has been demonstrated to have an anti-tumor activity but the underlying molecular mechanisms are not fully uncovered. The present study was undertaken to determine the effect of curcumin on the expression of the proto-oncogene Ets-1 and the anti-apoptotic molecule Bcl-2 in human endometrial adenocarcinoma HEC-1-A cells. METHODS Confluent HEC-1-A cells were treated with curcumin at various doses for 16 h or at 60 microM for various time points. At the end of the designated treatments, changes in cell morphology, DNA fragmentation and protein contents of Ets-1 and Bcl-2 were determined, respectively, by light microscopy, DNA laddering assay and Western blot analysis. As an initial step towards understanding whether Ets-1 was a possible up-stream regulator of Bcl-2 expression in HEC-1-A cells and if so, whether curcumin could attenuate the Ets-1-induced up-regulation of Bcl-2 expression, cells were transiently transfected with an Ets-1/GFP (Green Fluorescence Protein) fusion construct and the transfectants were treated with 60 microM curcumin for 16 h, followed by whole cell lysate preparation for Western blot analysis of Bcl-2 protein contents. RESULTS Curcumin induced apoptosis-like morphological changes and DNA degradation and decreased basal levels of Ets-1 and Bcl-2 protein contents in HEC-1-A cells in a time- and dose-dependent manner. Overexpression of Ets-1 in the cell resulted in an increase in Bcl-2 protein contents and that increase was attenuated by curcumin treatment. CONCLUSIONS Curcumin down-regulates Ets-1 and Bcl-2 expression and induces apoptosis in HEC-1-A cells, suggesting a novel molecular mechanism for the anti-tumor activity of curcumin.
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Affiliation(s)
- Ziming Yu
- Department of Obstetrics and Gynecology, University of Wisconsin-Madison, 7E-Meriter Hospital, 202 South Park Street, Madison, WI 53715, USA.
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Kapucuoglu N, Aktepe F, Kaya H, Bircan S, Karahan N, Ciriş M. Immunohistochemical expression of PTEN in normal, hyperplastic and malignant endometrium and its correlation with hormone receptors, bcl-2, bax, and apoptotic index. Pathol Res Pract 2007; 203:153-62. [PMID: 17317031 DOI: 10.1016/j.prp.2007.01.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2006] [Revised: 12/21/2006] [Accepted: 01/04/2007] [Indexed: 11/29/2022]
Abstract
PTEN is a tumor suppressor gene that is frequently mutated in type I endometrioid endometrial carcinomas (EECs), and is involved in the control of cell proliferation, differentiation, and apoptosis. In this study, we aimed to assess the relationship between PTEN expression and estrogen, progesterone receptors (PRs), other apoptosis-related proteins, such as bcl-2 and bax, and apoptotic index (AI) in EEC, its precursor lesion hyperplasia, and cyclical endometrium. We also evaluated the relationship between PTEN expression and clinicopathologic parameters. PTEN, estrogen receptor (ER), PR, and bcl-2 and bax expressions were evaluated immunohistochemically, and AI was evaluated in hematoxylin and eosin (HE)-stained slides in 23 cyclical and 37 hyperplastic endometria and in 35 EECs. PTEN expression was higher in cyclical endometrium than in the carcinomas (p<0.05). The PTEN expression level was significantly higher in non-atypical hyperplasias than in EEC, but there were no differences between atypical complex hyperplasia (ACH) and EEC and between hyperplasias. In the carcinomas, there was a negative correlation between grade and PTEN expression (r=-0.338, p=0.047). In conclusion, we presume that PTEN is involved in the early phases of endometrial tumorigenesis, and it can be speculated that decreased PTEN expression with loss of differentiation in carcinoma can contribute to the emergence of tumors with a more aggressive phenotype.
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Affiliation(s)
- Nilgun Kapucuoglu
- Department of Pathology, Suleyman Demirel University, 32260 Cünür, Isparta, Turkey.
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Villavicencio A, Bacallao K, Gabler F, Fuentes A, Albornoz J, Casals A, Vega M. Deregulation of tissue homeostasis in endometria from patients with polycystic ovarian syndrome with and without endometrial hyperplasia. Gynecol Oncol 2007; 104:290-5. [PMID: 17030058 DOI: 10.1016/j.ygyno.2006.09.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2006] [Revised: 08/28/2006] [Accepted: 09/01/2006] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To study the proteins involved in endometrial homeostasis in PCOS women. METHODS Protein expression of Ki67, Bcl-2, Bax, Pro-Caspase-3 and Caspase-3 by immunohistochemistry and/or Western blot, and DNA fragmentation using in situ 3'-end labeling of apoptotic cells, was measured in 9 samples of normal endometrium (NE), 12 PCOS endometria without treatment (PCOSE), 7 endometria from PCOS women with endometrial hyperplasia (HPCOSE) and 9 endometria from patients with endometrial hyperplasia (HE). RESULTS Cell proliferation was higher in epithelium from PCOSE (P<0.05), HPCOSE and HE vs NE. A higher Bcl-2/Bax relative ratio in PCOSE and HPCOSE was observed, in absence of active Caspase-3 and scarce DNA fragmentation in the four groups of endometria studied. CONCLUSION As the apoptosis was scarce in all of the groups studied, endometrial homeostasis deregulation in PCOS could be a result of increased proliferation. Therefore, the onset of endometrial hyperplasia in PCOS endometrium could be linked to inadequate cell proliferation, and concomitantly to inadequate cell survival.
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Affiliation(s)
- A Villavicencio
- Institute of Maternal and Child Research, School of Medicine, P.O. Box 226-3, and Pathology Department, San Borja-Arriarán Clinical Hospital, University of Chile, Santiago, Chile
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Havelka P, Oborná I, Brezinová J, Lichnovský V. Apoptosis and expression of Bcl-2 in human endometrium in natural and artificial cycles. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2005; 149:303-7. [PMID: 16601777 DOI: 10.5507/bp.2005.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Apoptosis plays a significant role in differentiation of many organs and helps to maintain homeostasis. The occurrence of apoptosis (using the apoptotic index) and expression of regulation protein Bcl-2 in the human endometrium was evaluated within the secretory phase of both the natural cycle, and an artificial one. Oral hormonal substitution used in this design induced similar, but more marked dynamic changes in Bcl-2 expression in the mid-secretory endometrium as were observed in the natural cycle, primarily in the surface and glandular epithelium of the endometrium. The apoptosis revealed similar a trend, but not significantly different.
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Affiliation(s)
- Pavel Havelka
- Institute of Histology and Embryology, Hnĕvotínská 3, Palacky University, Olomouc, Czech Republic.
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Di Paola M, Loverro G, Caringella AM, Cormioselvaggi GL. Receptorial and mitochondrial apoptotic pathways in normal and neoplastic human endometrium. Int J Gynecol Cancer 2005; 15:523-8. [PMID: 15882180 DOI: 10.1111/j.1525-1438.2005.15319.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Under normal conditions, in human endometrium, apoptotic and antiapoptotic factors play an important role in tissue homeostasis. Abnormalities of apoptosis, a process implicated in several events in the reproductive organs, may contribute to neoplastic transformation. The present study aimed to investigate the involvement of both the receptorial and the mitochondrial pathways of apoptosis in normal endometrium and in endometrial carcinoma, by measuring caspase-3 and caspase-8 activities and cytosolic cytochrome c levels. Twelve endometrial carcinomas and nine normal endometrial specimens (four in mild proliferative phase, five in late secretory phase) were included in this study. Cytosolic fractions, obtained by differential centrifugation of tissue homogenates, were analyzed for caspase-3 and caspase-8 activities, as well as for cytochrome c content. Caspase-8 activity in normal secretory phase endometrium was higher than that in the proliferative phase and in the endometrial carcinoma. Moreover, higher cytochrome c levels were detected in endometrial carcinoma with respect to normal secretive endometrium. No significant differences were found in caspase-3 activity between normal and pathologic endometrium. The results obtained suggest that in normal endometrium, apoptosis takes place through the activation of both receptorial and mitochondrial pathways. Defects in both these pathways may contribute to the development of endometrial carcinoma.
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Affiliation(s)
- M Di Paola
- Institute of Biomembranes and Bioenergetics, Consiglio Nazionale delle Ricerche, Bari, Italy
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Dahmoun M, Odmark IS, Risberg B, Karlsson MG, Pavlenko T, Bäckström T. Apoptosis, proliferation, and sex steroid receptors in postmenopausal endometrium before and during HRT. Maturitas 2004; 49:114-23. [PMID: 15474755 DOI: 10.1016/j.maturitas.2003.12.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2003] [Revised: 11/09/2003] [Accepted: 12/01/2003] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Endometrial homeostasis, indicated as the balance between apoptosis and proliferation, was studied with regard to endometrial safety and bleeding disturbances. MATERIALS AND METHODS The quantitatively sufficient endometrial biopsies of 92 postmenopausal women enrolled in the study were investigated. The participants were divided into two groups, each receiving a continuous combined HRT regimen with either conjugated estrogen (CE) 0.625 mg + 5 mg medroxyprogesterone acetate (MPA) (=CE/MPA) or 17-beta-estradiol (E2) 2 mg + 1 mg norethisterone acetate (NETA) (=E2/NETA). These were evaluated according to apoptotic index (Ai) and proliferation marker Ki-67 index. Estrogen receptor alpha (ER) and progesterone receptor (PR) expression were also monitored, as well as endometrial thickness. Quantitative in situ techniques were used. RESULTS Ai and Ki-67 index were unchanged in epithelial glands of endometrium from baseline to second biopsy obtained after 1 year of combined continuous HRT. In stromal tissue, Ki-67 index was increased, while Ai was on the same level. PR expression in both epithelium and stroma was unchanged. Endometrial thickness was unaffected during therapy, and the histopathological evaluation showed no development of hyperplasia or carcinoma. CONCLUSIONS The unaffected homeostasis in endometrial epithelium contributes to endometrial safety and is in accordance with the histopathological findings of no hyperplasia. The homeostasis of stroma was transformed to be more proliferative. Increased stromal proliferation may be of importance for stromal support of the veins and for decreasing breakthrough bleeding during HRT. The increased stromal proliferation, as well as the decreased ER expression both in epithelium and stroma, could be an effect of progesterone.
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Affiliation(s)
- Marju Dahmoun
- Department of Obstetrics and Gynecology, Mid Sweden Research and Development Center, Sundsvall Hospital, SE-851 86 Sundsvall, Sweden.
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Atasoy P, Bozdoğan O, Erekul S, Bozdoğan N, Bayram M. Fas-mediated pathway and apoptosis in normal, hyperplastic, and neoplastic endometrium. Gynecol Oncol 2003; 91:309-17. [PMID: 14599860 DOI: 10.1016/s0090-8258(03)00411-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Abnormalities in the control of cell proliferation and apoptosis have been suggested to contribute to the development and progression of neoplasia. There are at least two pathways that activate apoptosis. The first is a mitochondria-dependent route governed by bcl-2 family proteins. The second is a parallel mechanism which involves the activation of a group of tumor necrosis factor (TNF) receptors, such as Fas. METHODS The aim of this study was to examine the distribution and interrelation between the expression patterns of apoptosis-related proteins such as Fas, caspase-3 (CPP32), and M30, and to investigate the role of Fas-mediated apoptosis in the pathogenesis and progression of endometrial neoplasms. RESULTS Using specific antibodies for Fas, caspase-3, and M30, we examined protein expressions in 29 endometrial carcinomas, 30 endometrial hyperplasias, and 21 normal cyclic endometria. The results of immunostaining for Fas and caspase-3 were analyzed semiquantitatively by using an immunohistochemical scoring system (HSCORE) that incorporated both the intensity and the distribution of specific staining. For M30, positive staining cells and extracellular particles were analyzed semiquantitatively per 10 high-power fields.HSCOREs of Fas and caspase-3 were slightly higher in the secretory endometria than in the proliferative endometria. Similarly, M30 reactivity seemed to increase in the late secretory phase of the cycle. HSCOREs of Fas and caspase-3 and the reactivity of M30 were significantly higher in the carcinoma group than in the simple hyperplasia group (P < 0.05). Complex hyperplasias, however, expressed quite similar HSCOREs of Fas and caspase-3 as carcinomas. M30 reactivity was also significantly higher in complex hyperplasias than in simple hyperplasias, and in carcinomas positivity increased significantly (P < 0.05) as the grade progressed. CONCLUSIONS The significant increase observed in Fas, caspase-3, and M30 expression in carcinomas as compared with simple hyperplasias may suggest that the Fas-related apoptotic pathway is also involved in the regulation of apoptosis in the endometrial tissue and promotes the development and progression of endometrial neoplasia.
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Affiliation(s)
- Pinar Atasoy
- Department of Pathology, Kirikkale University School of Medicine, Turkey.
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Bozdoğan O, Atasoy P, Erekul S, Bozdoğan N, Bayram M. Apoptosis-related proteins and steroid hormone receptors in normal, hyperplastic, and neoplastic endometrium. Int J Gynecol Pathol 2002; 21:375-82. [PMID: 12352186 DOI: 10.1097/00004347-200210000-00007] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to evaluate the distribution and frequency of apoptosis-related proteins and their correlation with estrogen, progesterone, and androgen receptors in endometrial tissues. Immunohistochemical analyses of bcl-2, bax, bcl-x, and steroid receptors were performed in 22 endometrial carcinomas, 26 endometrial hyperplasias, and 19 cases of normal cyclical endometrium. Bcl-2 was expressed in 45.4% of carcinomas and 92.3% of hyperplasias. Bax immunostaining was found in 90.9% of carcinomas and 76.9% of hyperplasias. Bcl-x positivity was similar in carcinomas (68.1%) and endometrial hyperplasias (76.9%). In normal cyclical endometria, bcl-2 staining was intense and diffuse in the proliferative phase, but decreased dramatically in the early and mid-secretory phase to reappear in the late secretory phase. Bax was expressed throughout the menstrual cycle but more strongly in the secretory phase. Bcl-x displayed a similar degree of expression in proliferative and secretory endometria. Nineteen carcinomas (86.3%), 25 hyperplasias (96.1%), and 18 normal cyclical endometria (94.7%) were positive for estrogen receptor (ER). Progesterone receptor (PR) was observed in 20 carcinomas (90.9%), all hyperplasias (100%), and 18 normal cyclical endometria (94.7%). Androgen receptor (AR) positivity was seen in 7 carcinomas (31.8%), 6 hyperplasias (23.0%), and 3 normal cyclical endometria (15.7%). There was a statistically positive correlation between bcl-x and ER and a tendency toward significant correlation between bcl-x and PR and between ER and PR in carcinomas. In hyperplasias, there was a significant positive correlation between bcl-2 and PR and between bcl-2 and bax and a negative correlation between ER and bax. There was a statistically significant difference for bcl-2 (p = 0.001) and bax (p = 0.001) between the hyperplasia and carcinoma groups. There was increased expression of bax, decreased expression of bcl-2, and persistence of bcl-x protein in advanced endometrial carcinomas. Our findings show that ovarian hormones have a regulatory role on bcl-2 protein and that there is a correlation between other members of the bcl-2 family (bcl-x and bax) and steroid hormone receptors. Bax/bcl-x may be the major control mechanisms of apoptosis in advanced carcinomas; other members of the bcl-2 family may also be under hormonal control.
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Affiliation(s)
- Onder Bozdoğan
- Kirikkale University Faculty of Medicine, Kirikkale State Hospital, Turkey
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