Endometriosis

How does chronic endometritis influence pregnancy outcomes in endometriosis associated infertility? A retrospective cohort study

BACKGROUND

Endometriosis (EMS) and chronic endometritis (CE) frequently coexist. This study aimed to examine the impact of CE on reproductive outcomes in patients with EMS.

METHODS

We enrolled 685 patients with endometriosis-associated infertility from January 2018 to December 2020. The patients were divided into CE (318) and non-CE (367) groups. A subset of 123 clinically pregnant women from the CE group and 369 from the non-CE group was selected for detailed comparison. Pregnancy and delivery data were meticulously collected from hospital records and through telephone interviews.

RESULTS

CE was diagnosed in 46.42% of EMS patients. Higher pregnancy rates were observed in patients with Endometriosis Fertility Index (EFI) scores of 7-10. EMS patients with CE had increased risks of placenta previa (13.01%), gestational hypertension (5.69%), and cesarean sections (59.34%).

CONCLUSIONS

CE, which is prevalent among EMS patients, is linked to increased risks of pregnancy complications, including placenta previa, gestational hypertension, and cesarean delivery. Although combined hysteroscopy and laparoscopy improve pregnancy rates, they demand careful management of these complications.

NEK2 promotes the development of ovarian endometriosis and impairs decidualization by phosphorylating FOXO1

Ovarian endometriosis is a common gynecological disease, and one of its most significant symptoms is infertility. In patients with endometriosis, defects in endometrial decidualization lead to impaired endometrial receptivity and embryo implantation, thus affecting early pregnancy and women's desire to have children. However, the mechanisms underlying the development of endometriosis and its associated defective decidualization are unclear. We find that NEK2 expression is increased in the ectopic and eutopic endometrium of patients with endometriosis. Meanwhile, NEK2 interacts with FOXO1 and phosphorylates FOXO1 at Ser184, inhibiting the stability of the FOXO1 protein. Importantly, NEK2-mediated phosphorylation of FOXO1 at Ser184 promotes cell proliferation, migration, invasion and impairs decidualization. Furthermore, INH1, an inhibitor of NEK2, inhibits the growth of ectopic lesions in mouse models of endometriosis and promotes endometrial decidualization in mouse models of artificially induced decidualization. Taken together, these findings indicate that NEK2 regulates the development of endometriosis and associated disorders of decidualization through the phosphorylation of FOXO1, providing a new therapeutic target for its treatment.

The roles of chromatin regulatory factors in endometriosis

PURPOSE

Endometriosis is an estrogen-dependent inflammatory disease and one of the most common gynecological diseases in women of reproductive age. The aim of the review was to explore the relationship between the chromatin regulatory factors and endometriosis.

METHODS

By searching for literature on chromatin regulators and endometriosis in PuMed. Finally, 98 documents were selected.

RESULTS

Chromatin regulators (CRs) are essential epigenetic regulatory factors that can regulate chromatin structure changes and are usually divided into three categories: DNA methylation compounds, histone modification compounds, and chromatin remodeling complexes. Noncoding RNAs are also chromatin regulators and can form heterochromatin by binding to protein complexes. Chromatin regulators cause abnormal gene expression by regulating chromatin structure, thereby affecting the occurrence and development of endometriosis.

CONCLUSION

This review summarizes the participation of chromatin regulators in the mechanisms of endometriosis, and these changes in related chromatin regulators provide a comprehensive reference for diagnosis and treatment of endometriosis.

Chronic Stress Blocks the Endometriosis Immune Response by Metabolic Reprogramming

Studies have shown that the occurrence and development of endometriosis are closely linked to long-term psychological stress. The specific contribution of chronic stress to the metabolic adaptations in patients with endometriosis is still unknown. Lesions were removed from ten endometriosis patients during an operation, and the participants were divided into two groups using a psychological questionnaire. An mRNA Human Gene Expression Microarray analysis was applied to compare the mRNA expression profiles between the chronic stress group and the control group. In addition, the reliability of the mRNA Human Gene Expression Microarray analysis was verified by using research on metabolites based on both the liquid chromatography (LC-MS/MS) technique and quantitative reverse transcription polymerase chain reaction (RT-PCR). A microarray analysis of significantly up-regulated, differentially expressed genes between the chronic stress and the control groups showed genes that were principally related to metabolism-related processes and immune-related processes, such as the immune response process, negative regulation of T cell proliferation, the leucine metabolic process, and the L-cysteine metabolic process (p < 0.05). LC-MS showed that the differential metabolites were primarily concerned with arginine and proline metabolism, D-glutamine and D-glutamate metabolism, aspartate metabolism, glycine, serine metabolism, and tyrosine metabolism (p < 0.05). The possibility of chronic stress blocks the endometriosis immune response through metabolic reprogramming. Chronic stress reduces the supply of energy substrates such as arginine and serine, down-regulates T immune cell activation, and affects the anti-tumor immune response, thereby promoting the migration and invasion of endometriosis lesions in patients with chronic stress.

Macrophages originated IL-33/ST2 inhibits ferroptosis in endometriosis via the ATF3/SLC7A11 axis

Endometriosis is a gynecological inflammatory disease that is linked with immune cells, specifically macrophages. IL-33 secreted from macrophages is known to accelerate the progression of endometriosis. The periodic and repeated bleeding that occurs in women with endometriosis leads to excess iron in the microenvironment that is conducive to ferroptosis, a process related to intracellular ROS production, lipid peroxidation and mitochondrial damage. It is suggested that eESCs may specifically be able to inhibit ferroptosis. However, it is currently unclear whether IL-33 directly regulates ferroptosis to influence the disease course in endometriosis. In this study, eESCs co-cultured with macrophages or stimulated with IL-33/ST2 were observed to have increased cell viability and migration. Additionally, IL-33/ST2 decreased intracellular iron levels and lipid peroxidation in eESCs exposed to erastin treatment. Furthermore, IL-33/ST2 treatment resulted in a notable upregulation in SLC7A11 expression in eESCs due to the downregulation of negative transcription factor ATF3, thereby suppressing ferroptosis. The P38/JNK pathway activated by IL-33/ST2 was also found to inhibit the transcription factor ATF3. Therefore, we concluded that IL-33/ST2 inhibits the ATF3-mediated reduction in SLC7A11 transcript levels via the P38/JNK pathway. The findings reveal that macrophage-derived IL-33 upregulates SLC7A11 in eESCs through the p38/JNK/ATF3 pathway, ultimately resulting in protection against ferroptosis in eESCs. Moreover, we conducted an experiment using endometriosis model mice that showed that a combination of IL-33-Ab and erastin treatment alleviated the disease, showing the promise of combining immunotherapy and ferroptosis therapy.

Perianal Endometriosis: An Uncommon Site for a Common Problem

Endometriosis is the presence of uterine glands and stroma outside of the uterus. It is highly prevalent in women of reproductive age. It is usually found in the pelvis, with most cases being found on the peritoneum, ovaries, or deep in the pelvis. Extraperitoneal endometriosis is uncommon. Perianal endometriosis has an incidence of only 0.2%. We present the case of a 37-year-old woman with recurrent pain and swelling in the perineum at the site of a previous episiotomy scar. Initial imaging and assessment determined this to be scar tissue. Following re-presentation, it was mistakenly diagnosed as a perianal abscess, and the patient underwent incision and drainage. The wound failed to heal with significant induration. Further assessment of the wound was undertaken under general anesthesia. An excision of the affected area was performed, with histological analysis confirming endometriosis. This case highlights that extra-peritoneal endometriosis is a rare but treatable cause of recurrent, cyclical pelvic pain and swelling in the perineum. A high index of clinical suspicion is required due to its ability to mimic other pathologies, including abscesses and cysts. The primary management of perianal endometriosis is surgical excision. Where complete excision is not possible, medical management with hormone therapy should be considered.