Environmental contaminants and dietary factors in endometriosis

Congenital scoliosis: an anomalous association with endosulfan

Endosulfan is an organochlorine pesticide that is used extensively across the world to kill insects. Incidence of acute and chronic toxicity with endosulfan poisoning has been reported, and nearly 80 countries have banned its use. However, it is still being used in many low-income/middle-income countries. One of the most severe tragedies because of endosulfan poisoning has taken place in the Indian state of Kerala due to persistent aerial spraying of endosulfan. Even though there are reports of skeletal and other congenital abnormalities in humans and experimental animals following exposure to endosulfan, very few have been documented. We report two cases of congenital scoliosis in siblings living in a community affected by high levels of endosulfan in the environment. High index of suspicion is essential during the screening of school children exposed to endosulfan. Congenital scoliosis is a progressive deformity that leads to severe disability, unless detected and corrected at an early stage.

[Pathogenesis, genetics and diagnosis of endometriosis]

Endometriosis is a multifactorial pathology. Trans-tubal reflux theory remains valid. Genetic and epigenetic factors associated with immunological perturbations are involved. The role of endocrine disruptors is discussed although epidemiological studies are contradictory. Therapeutics are primarily based on hormonal treatments but better understanding of pathophysiology should allow targeted non-hormonal therapy. The clinical examination is sometimes negative, which should not eliminate the diagnosis and imposes complementary examinations as best as possible by referents.

A study of DNA damage in buccal cells of consumers of well- and/or tap-water using the comet assay: Assessment of occupational exposure to genotoxicants

Because of concerns that natural aquifers in the region of Todos Santos (Baja California Sur, Mexico) might be contaminated by organochlorine pesticides and heavy metals, a case-control study was conducted among consumers and non-consumers of well- and/or tap-water to determine risks to human health. This study was based on a genotoxic evaluation of buccal cells using the Comet assay technique. Levels of DNA damage in the consumers group were significantly higher than those of the control group. However, occupational exposure to genotoxicants showed to be the critical factor rather than water consumption. Taking into account the professions of well- and/or tap-water consumers, agricultural workers exposed directly (those who fumigated) or indirectly (those not involved in fumigating) to agrochemicals showed greater genetic damage than controls. This difference persisted even when age, and whether the person smoked or consumed alcoholic drinks were considered. These factors were not associated with the level of genetic damage observed. Chemical analyses of organochlorine pesticides and heavy metals were carried out to evaluate the water quality of wells, faucets, and surface water of canals consumed by the population and/or used for irrigation. High concentrations of α and β endosulfan were detected in water of surface canals. Although our inventory of agrochemicals employed in the region showed the use of products considered carcinogenic and/or mutagenic, they were not detected by the analytical techniques used. Heavy metals (arsenic, mercury, and lead) were detected in water of some wells used for irrigation and human consumption. Environ. Mol. Mutagen. 58:619-627, 2017. © 2017 Wiley Periodicals, Inc.

Hormonal contraceptive use and the prevalence of endometriotic lesions at different regions within the peritoneal cavity

Endometriosis is an estrogen-dependent disease that can lead to chronic pain and subfertility. Endometriotic lesions found in different locations are heterogeneous and may represent a collection of related but distinct conditions. Whether there is a relationship between hormonal contraceptive (HC) use and endometriosis is still controversial. The purpose of this study was to determine whether HC use affected the prevalence of endometriotic lesions differently based on lesion location. Data was retrospectively collected from 161 patients presenting to the Berne University Women's Hospital between 2008 and 2012 for laparoscopic investigation. Women with histologically proven endometriosis were included in the study and patients were grouped according to lesion location and HC use. The results of the study indicate that HC users are significantly less likely to have endometriotic lesions on the ovaries, although in contrast, no difference was observed in the incidence of lesions in the rectovaginal septum (RVS) or peritoneal region. In addition, women using HC who were diagnosed with endometriotic lesions on the peritoneum were significantly younger than women with lesions in other locations. In conclusion, women with endometriosis who are currently using HC are less likely to have ovarian endometriotic lesions than in alternate locations.

Alcohol, drugs, caffeine, tobacco, and environmental contaminant exposure: reproductive health consequences and clinical implications

Reproductive function and fertility are thought to be compromised by behaviors such as cigarette smoking, substance abuse, and alcohol consumption; however, the strength of these associations are uncertain. Furthermore, the reproductive system is thought to be under attack from exposure to environmental contaminants, particularly those chemicals shown to affect endocrine homeostasis. The relationship between exposure to environmental contaminants and adverse effects on human reproductive health are frequently debated in the scientific literature and these controversies have spread into the lay press drawing increased public and regulatory attention. Therefore, the objective of the present review was to critically evaluate the literature concerning the relationship between lifestyle exposures and adverse effects on fertility as well as examining the evidence for a role of environmental contaminants in the purported decline of semen quality and the pathophysiology of subfertility, polycystic ovarian syndrome, and endometriosis. The authors conclude that whereas cigarette smoking is strongly associated with adverse reproductive outcomes, high-level exposures to other lifestyle factors are only weakly linked with negative fertility impacts. Finally, there is no compelling evidence that environmental contaminants, at concentrations representative of the levels measured in contemporary biomonitoring studies, have any effect, positive or negative, on reproductive health in the general population. Further research using prospective study designs with robust sample sizes are needed to evaluate testable hypotheses that address the relationship between exposure and adverse reproductive health effects.

Environmental and host-associated risk factors in endometriosis and deep endometriotic nodules: a matched case-control study

Peritoneal endometriosis (PE) and deep endometriotic nodules (DEN) are gynecological diseases recently shown to be associated with elevated serum concentrations of organochlorines. The objective of the present study was to compare risk factors associated with both forms of the disease, with a particular attention to potential sources of organochlorine exposure. This matched case-control study with prospective recruitment included 88 triads (PE-DEN-control). All women were face-to-face interviewed with a standardized questionnaire, and serum dioxin and polychlorinated biphenyl measurements were available for 58 of them. Alcohol consumption (odds ratio (OR): 5.82 [confidence interval at 95% (95%CI) 1.20-28.3]) in DEN and low physical activity at work for DEN (OR: 4.58 [95%CI 1.80-11.62]) and PE (OR: 5.61 [95%CI 1.90-16.60]) were traced as significant risk factors. Organochlorine-related factors (use of tampons, occupational or environmental exposure) were not related to the disease. The current consumption of foodstuffs that were more likely to contribute to organochlorine body burden did not differ among the groups. Only some of these fatty foodstuffs (marine fish, pig meat) were traced by multiple regression analysis as significant determinants of organochlorine body burden, explaining only a small fraction (20%) of the interindividual variation of organochlorine body burden. We conclude that PE and DEN share similar patterns of risk or protective factors.

Serum dioxin-like compounds and aromatase (CYP19) expression in endometriotic tissues

Dioxin-like compounds (DLCs) are suspected etiological factors of endometriosis but their potential mechanisms of action remain elusive. Because endometriosis is an estrogen-dependent disease and since aromatase (CYP19), a key enzyme in estrogen biosynthesis, was recently demonstrated to be expressed in endometriotic lesions, we hypothesized that dioxin-like compounds could modulate local estrogen production through an up-regulation of aromatase. We tested this hypothesis by examining the correlation between serum DLC levels and CYP19 expression in endometriotic tissue obtained from 47 patients with peritoneal, ovarian endometriosis and/or deep endometriotic nodules of the rectovaginal septum. Aromatase expression was assessed by real-time RT-PCR in biopsied endometriotic tissues [peritoneal (n=19), ovarian (n=17) endometriosis and deep endometriotic nodules of the recto-vaginal septum (n=29)]. The relationship between aromatase expression and DLCs was traced by simple regression analysis. DLCs did not appear to be significant determinants of aromatase expression. CYP1A1 expression, measured as a positive control, was found associated with current smoking but not with DLCs. We conclude that DLCs do probably not facilitate the growth of endometriotic lesions by up-regulating the local expression of aromatase.

Expression of interleukin-8 and monocyte chemotactic protein-1 in adenomyosis

BACKGROUND

To clarify the inflammatory nature of adenomyosis, we aimed to investigate the expression of interleukin-8 (IL-8) and monocyte chemotactic protein-1 (MCP-1) by immunohistochemistry to determine their putative role in pathophysiology of adenomyosis.

METHODS

Adenomyosis samples, with their eutopic endometrium, were collected from 30 women undergoing hysterectomy. Endometrium from 27 women without adenomyosis were also collected as a control group. Samples were grouped according to the menstrual cycle phase and examined by immunohistochemistry for IL-8 and MCP-1.

RESULTS

In normal endometrium, secretory phase samples expressed higher levels of epithelial IL-8 than in proliferative phase samples (P = 0.01), and we observed a trend for an increased epithelial MCP-1 expression in the secretory phase samples compared with the proliferative phase samples (P = 0.07). Endometrial samples of women with adenomyosis did not show the same cyclic variation. In the secretory phase, eutopic endometrium of women with adenomyosis expressed lower levels of epithelial IL-8 and MCP-1 compared with normal endometrium (P < 0.05). The expression of epithelial IL-8 and MCP-1 was higher in the adenomyosis foci than the eutopic endometrium (P < 0.05).

CONCLUSIONS

These findings may indicate that an intrinsic abnormality of inflammatory response may be present in eutopic endometrium of women with adenomyosis, and IL-8 and MCP-1 may contribute to the pathophysiology of adenomyosis.

Transactivation of steroidogenic acute regulatory protein in human endometriotic stromalcells is mediated by the prostaglandin EP2 receptor

Steroidogenic acute regulatory protein (StAR) regulates the first committed step in the biosynthesis of steroids, and thus aberrant expression of StAR in endometriotic implants plays a critical role in the etiology of endometriosis. However, the mechanism responsible for abnormal expression of StAR in ectopic endometriotic tissues remains unknown. In the present study, we demonstrate that prostaglandin (PG) E(2) stimulates StAR protein expression at the cellular and molecular levels. PGE(2) caused a rapid increase in StAR expression that involves activation of the EP2 receptor-coupled protein kinase A pathway. Activation of EP2 receptor-induced phosphorylation of ERK and cAMP response element binding protein (CREB). However, activation of ERK did not involve in CREB phosphorylation or concomitantly StAR expression. Phosphorylation of CREB induced by PGE(2) increased the recruitment of CREB binding protein and thus histone H3 acetylation. Chromatin immunoprecipitation experiments showed that acetylated histone H3 bound to the proximal region of the StAR promoter was increased after 30 min treatment with PGE(2), and this was mirrored by an increase in nascent StAR RNA transcription. Treatment with the histone deacetylase inhibitor, tricostatin A, enhanced PGE(2)-induced nascent StAR RNA transcription. We conclude that increased histone H3 acetylation involving the EP2 receptor, protein kinase A, CREB, and CREB binding protein is responsible for PGE(2)-induced StAR gene activation in endometriotic stromal cells. Our current report may provide new insights in understanding mechanism of abnormally local production of estrogen and the etiology of endometriosis.

Do environmental contaminants adversely affect human reproductive physiology?

There is increasing concern among Canadian women that unwitting and unwanted exposures to environmental contaminants are adversely affecting their health, particularly their ability to become pregnant and have a healthy baby. Evidence of adverse reproductive outcomes among populations exposed to environmental contaminants in the workplace via accidental poisoning, together with detection of environmental contaminant residues in serum and ovarian follicular fluid, has led to the hypothesis that chemical contaminants may be contributing to adverse reproductive outcomes such as infertility, endometriosis, polycystic ovary syndrome, spontaneous abortion, preterm labour, intrauterine growth restriction, and pregnancy-induced hypertension in the general population. The lack of clear evidence concerning the association between exposure to environmental contaminants and adverse reproductive outcomes hampers the clinician's ability to counsel women who are trying to conceive or who have concerns about their pregnancy. This review summarizes the evidence linking environmental contaminant exposure to selected adverse health outcomes by examining the changes in health-outcome trends, the consistency of the epidemiological evidence of an association between the health outcome of concern and exposure to environmental contaminants, and the biological plausibility for environmental contaminant mediated effects on human reproductive health. At best, only a moderate association can be found linking exposure to environmental contaminants with evidence of deleterious reproductive effects in women. Lack of disease trend data, weak exposure assessments, and limited mechanistic data supporting the biological plausibility of potential effects are the primary limitations to the hypothesis that exposure to environmental contaminants adversely affects human reproductive physiology.

Adolescent endometriosis

PURPOSE OF REVIEW

Endometriosis can exist in the adolescent female. It can be a very disruptive disease and cause significant dysfunction at a time in life when self-esteem, school attendance, and school performance are critical to achievement of life goals. Approaches to diagnosis and management in the recent literature are reviewed, focusing on those that apply directly to the adolescent or indirectly, by extrapolation from work done in the adult population. Practical strategies for adolescent patient care are presented.

RECENT FINDINGS

Recent research has focused on the efficacy of current treatment modalities and management of potential adverse side effects. Possible etiologies of endometriosis have been proposed, and therapies directed at those causes are being explored. Methods of diagnosis, both invasive and noninvasive, have been studied in order to determine the most effective way of diagnosing the disease.

SUMMARY

A better understanding of the etiology of endometriosis would probably assist in determining the most suitable treatment strategies. Future work in adolescent endometriosis should focus on developing safe, minimally invasive, yet definitive options for diagnosis and treatment.