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Zheng W, Xiang D, Wen D, Luo M, Liang X, Cao L. Identification of key modules and candidate genes associated with endometriosis based on transcriptome data via bioinformatics analysis. Pathol Res Pract 2023; 244:154404. [PMID: 36996608 DOI: 10.1016/j.prp.2023.154404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 02/16/2023] [Accepted: 03/02/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUNDS Endometriosis is a common disease in women, but the signaling pathways and genes involved remain unclear. This study screened genes that were differentially expressed in ectopic endometrium (EC) and eutopic endometrium (EU) in endometriosis and provided clues for subsequent experimental verification. METHODS Endometriosis samples were harvested from inpatients that underwent surgery from 2017 to 2019 with pathological evidence of endometriosis. We assessed the mRNA expression profiles in endometriosis and further conducted gene ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis, Gene Set Enrichment Analysis (GSEA) and weighted gene co-expression network analysis (WGCNA) to identify potential biomarkers in endometriosis. Finally, we further validated hub genes using public databases and immunohistochemistry assays. RESULTS The upregulated DEGs of ectopic endometrium from endometriosis patients were mainly involved in cell adhesion, MAPK signaling, PI3K-Akt signaling pathways, cytokine receptor interactions, and epithelial-mesenchymal transformation (EMT)-associated signaling pathways. The downregulated DEGs between ectopic endometrium and eutopic endometrium were related to decidualization-associated genes in endometriosis. The correlated gene modules in eutopic endometrial cells were mainly enriched in cell adhesion, embryo implantation and inflammation. The eutopic and ectopic endometrial lesions in endometriosis were involved in the EMT process. Furthermore, we identified 18 co-expression modules during WGCNA analysis. Hub genes in the pale turquoise module were FOSB, JUNB, ATF3, CXCL2, FOS, etc. Significantly enriched KEGG pathways included the TNF, MAPK, foxO, oxytocin, and p53 signaling pathways. Enrichment pathways were directly related to immune surveillance, stem cell self-renewal, and epithelial-mesenchymal transformation. Several pathways and modules of endometriosis are related to cancer-associated pathways, which substantiates the correlation between endometriosis and various gynecological tumors. CONCLUSIONS Endometriosis was tightly correlated with EMT and fibrosis mediated by inflammatory immunity, cytokines, estrogen, kinases and protooncogene through transcriptomics. Overall, our findings lay the groundwork for understanding the pathogenesis of endometriosis and its relationship with malignant transformation.
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Affiliation(s)
- Weilin Zheng
- Traditional Chinese Medicine Department, Guangdong Second Provincial General Hospital, Guangdong Provincial Emergency Hospital, Guangzhou, China
| | - Dongfang Xiang
- Department of Gynecology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Danting Wen
- Department of Gynecology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Meicheng Luo
- Department of Gynecology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xuefang Liang
- Department of Gynecology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Lixing Cao
- Department of Gynecology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
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Kołat D, Kałuzińska Ż, Bednarek AK, Płuciennik E. Prognostic significance of AP-2α/γ targets as cancer therapeutics. Sci Rep 2022; 12:5497. [PMID: 35361846 PMCID: PMC8971500 DOI: 10.1038/s41598-022-09494-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/24/2022] [Indexed: 02/07/2023] Open
Abstract
Identifying genes with prognostic importance could improve cancer treatment. An increasing number of reports suggest the existence of successful strategies based on seemingly "untargetable" transcription factors. In addition to embryogenesis, AP-2 transcription factors are known to play crucial roles in cancer development. Members of this family can be used as prognostic factors in oncological patients, and AP-2α/γ transcription factors were previously investigated in our pan-cancer comparative study using their target genes. The present study investigates tumors that were previously found similar with an emphasis on the possible role of AP-2 factors in specific cancer types. The RData workspace was loaded back to R environment and 3D trajectories were built via Monocle3. The genes that met the requirement of specificity were listed using top_markers(), separately for mutual and unique targets. Furthermore, the candidate genes had to meet the following requirements: correlation with AP-2 factor (through Correlation AnalyzeR) and validated prognostic importance (using GEPIA2 and subsequently KM-plotter or LOGpc). Eventually, the ROC analysis was applied to confirm their predictive value; co-dependence of expression was visualized via BoxPlotR. Some similar tumors were differentiated by AP-2α/γ targets with prognostic value. Requirements were met by only fifteen genes (EMX2, COL7A1, GRIA1, KRT1, KRT14, SLC12A5, SEZ6L, PTPRN, SCG5, DPP6, NTSR1, ARX, COL4A3, PPEF1 and TMEM59L); of these, the last four were excluded based on ROC curves. All the above genes were confronted with the literature, with an emphasis on the possible role played by AP-2 factors in specific cancers. Following ROC analysis, the genes were verified using immunohistochemistry data and progression-related signatures. Staining differences were observed, as well as co-dependence on the expression of e.g. CTNNB1, ERBB2, KRAS, SMAD4, EGFR or MKI67. In conclusion, prognostic value of targets suggested AP-2α/γ as candidates for novel cancer treatment. It was also revealed that AP-2 targets are related to tumor progression and that some mutual target genes could be inversely regulated.
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Affiliation(s)
- Damian Kołat
- Department of Molecular Carcinogenesis, Medical University of Lodz, 90-752, Lodz, Poland.
| | - Żaneta Kałuzińska
- Department of Molecular Carcinogenesis, Medical University of Lodz, 90-752, Lodz, Poland
| | - Andrzej K Bednarek
- Department of Molecular Carcinogenesis, Medical University of Lodz, 90-752, Lodz, Poland
| | - Elżbieta Płuciennik
- Department of Molecular Carcinogenesis, Medical University of Lodz, 90-752, Lodz, Poland
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Abstract
Endometriosis-associated ovarian malignancies have been well documented. Although these malignancies also occur as extraovarian lesions, little is known about them. Thus, this literature review aimed to further explore these rarely experienced tumors. A total of 257 published cases between April 1990 and April 2020 were found using PubMed, and 212 cases were included in the analysis considering Sampson’s criteria and the history of endometriosis. We classified these cases as follows: intestine, abdominal scar, vagina and vulva, peritoneum and deep endometriosis, urinary tract, uterine cervix, and others. Age of patients, history of endometriosis, types of past hormonal therapy, symptoms, histological types, and treatment were identified. The most common tumor site was the intestine. Endometrioid carcinoma was the dominant histological type. Contrary to the ovary, clear cell carcinoma was rare in extraovarian sites. On the other hand, clear cell carcinoma represented the largest number of abdominal scars. This difference may help us to understand the development of endometriosis-related malignancies. Hormonal treatment was mentioned in 67 cases and estrogen replacement therapy in 33 cases. Although risks of estrogen therapy are still controversial, the highly differentiated histological types and hormone-dependent characteristics of endometriosis-associated malignancy should be considered. Physicians should be careful about estrogen monotherapy after hysterectomy and long-term hormone replacement therapy in patients with a history of endometriosis.
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Lu H, Hu H, Yang Y, Li S. The inhibition of reactive oxygen species (ROS) by antioxidants inhibits the release of an autophagy marker in ectopic endometrial cells. Taiwan J Obstet Gynecol 2020; 59:256-261. [PMID: 32127147 DOI: 10.1016/j.tjog.2020.01.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2019] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the role of oxidative stress and reactive oxygen species (ROS) in the pathogenesis of endometriosis (EMs) and to investigate the role of antioxidant therapy on autophagy and the outcome of EMs. MATERIALS AND METHODS Experimental rats were given an peritoneal perfusion of N-acetyl-l-cysteine (NAC, 200 mg/kg) or catalase (CAT, 2000 U/mL). Immunofluorescence was then used to detect microtubule-associated protein light chain 3 (LC3). Western blotting was used to determine the levels of Beclin-1 protein while enzyme-linked immunosorbent assays (ELISAs) were used to measure ROS levels after treatment. RESULTS Fluorescent in situ hybridization showed that NAC and CAT influenced the levels of LC3, an autophagy marker; there were significantly lower levels of LC3 fluorescence in the EMs group (surgical group) of rats compared with controls (p < 0.05). Western blot analysis revealed a downregulation of Beclin-1 protein in both the NAC and CAT groups (p < 0.05) while ELISA revealed significantly lower levels of ROS in the NAC and CAT groups (p < 0.05). CONCLUSION The antioxidants NAC and CAT significantly reduced levels of the autophagy marker LC3 and caused levels of Beclin-1 to significantly decrease. Consequently, antioxidant therapy shows potential for the future treatment of EMs.
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Affiliation(s)
- Huixia Lu
- Department of Gynecology, College of Clinical Medical, Dali University, Dali, 671000, China
| | - Hong Hu
- Department of Gynecology, College of Clinical Medical, Dali University, Dali, 671000, China
| | - Yi Yang
- Department of Anesthesiology, College of Clinical Medical, Dali University, Dali, 671000, China
| | - Shaobo Li
- Department of Spine Surgery, The First Affiliated Hospital of Dali University, Dali, 671000, China.
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Management of a Thin Endometrium by Hysteroscopic Instillation of Platelet-Rich Plasma Into The Endomyometrial Junction: A Pilot Study. J Clin Med 2020; 9:jcm9092795. [PMID: 32872571 PMCID: PMC7564727 DOI: 10.3390/jcm9092795] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 08/24/2020] [Accepted: 08/28/2020] [Indexed: 12/12/2022] Open
Abstract
In patients whose embryo transfer has been previously canceled due to a thin endometrium, the injection of platelet-rich plasma (PRP) guided by hysteroscopy into the endomyometrial junction improves endometrial thickness and vascularity. This may well serve as a novel approach for the management of these patients. In this study, 32 patients aged between 27 and 39 years, suffering from primary or secondary infertility, were selected for hysteroscopic instillation of PRP. This cross-sectional study included a retrospective assessment of the improvement of endometrial thickness (>7 mm) on the commencement of progesterone treatment in 24 of 32 patients (75%) after hysteroscopy-guided injections of PRP into the subendometrial zone. After PRP instillation, the endometrium was 7 mm or thicker in 24 of 32 patients, and all 24 patients underwent frozen embryo transfer. Moreover, 12 of 24 patients who underwent embryo transfer conceived, whereas 10 had a clinical pregnancy with visualization of cardiac activity at 6 weeks and two had a biochemical pregnancy. Our approach of PRP injection into the subendometrial region is consistent with the histologically proven regeneration of the endometrium from the endomyometrial junction. We observed an improvement of endometrial thickness and higher pregnancy rates in cases of previously canceled embryo transfer due to a thin endometrium.
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Pospisilova E, Kiss I, Souckova H, Tomes P, Spicka J, Matkowski R, Jedryka M, Ferrero S, Bobek V, Kolostova K. Circulating Endometrial Cells: A New Source of Information on Endometriosis Dynamics. J Clin Med 2019; 8:E1938. [PMID: 31717910 PMCID: PMC6912292 DOI: 10.3390/jcm8111938] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 10/22/2019] [Accepted: 11/04/2019] [Indexed: 11/17/2022] Open
Abstract
The focus of the presented work was to isolate and characterize circulating endometrial cells (CECs) enriched from peripheral blood (PB) of patients with diagnosed endometriosis. The molecular characteristics of CECs could be supportive for an understanding of endometriosis pathogenesis and treatment decisions in the future. MATERIAL AND METHODS Blood samples (n = 423) were tested for CECs presence. Subsequently, gene expression analysis (GEA) was carried out for CECs. In parallel, CECs presence and characteristics were tested during menstrual cycle (MC) phases in 11 patients. CECs were enriched by size-based separation. RESULTS CECs were present in 78.4% of the tested blood samples. In line with the revised American Fertility Society (rAFS) classification, CECs presence was confirmed in all the acknowledged endometriosis stages: minimal, mild, moderate, and severe. Surprisingly, CECs negativity rate was also reported for severe disease in 21.1% of cases. The CECs captured during MC phases displayed different cytomorphology, including epithelial, stromal, and stem cell-like characteristics. The highest CECs numbers were detected in the mid-secretory phase of MC, which corresponds to uterine lining decidualization. CECs captured during mid-secretory periods expressed genes KRT18, NANOG, and VIM in higher amounts when compared to the proliferative phase of MC, where genes KRT19 and ESR1 were mostly elevated. GEA of the super-positive CECs samples (1000 CECs/8 mL PB) revealed high expression of genes KRT18, VIM, NANOG, and FLT1. The expression of these genes was also elevated in the endometriosis tissue samples and endometrioma. CONCLUSION The panel of the identified CEC genes could be tested in a prospective manner to confirm the role of CECs in endometriosis pathogenesis and diagnostics.
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Affiliation(s)
- Eliska Pospisilova
- Department of Laboratory Genetics, Laboratory Diagnostics, Faculty Hospital Královské Vinohrady, Srobarova 50, 100 34 Prague 10, Czech Republic (V.B.)
- Department of Gynecology, Military University Hospital and 3rd Faculty of Medicine, U Vojenske nemocnice 1200, 169 02 Prague 6, Czech Republic
| | - Imrich Kiss
- Department of Laboratory Genetics, Laboratory Diagnostics, Faculty Hospital Královské Vinohrady, Srobarova 50, 100 34 Prague 10, Czech Republic (V.B.)
- Department of Gynecology, Military University Hospital and 3rd Faculty of Medicine, U Vojenske nemocnice 1200, 169 02 Prague 6, Czech Republic
- Department of Obstetrics and Gynecology, University Hospital, Faculty of Medicine Charles University, Alej Svobody 80, 301 66 Pilsen, Czech Republic
| | - Helena Souckova
- Department of Gynecology, Military University Hospital and 3rd Faculty of Medicine, U Vojenske nemocnice 1200, 169 02 Prague 6, Czech Republic
| | - Pavel Tomes
- Department of Obstetrics and Gynecology, University Hospital, Faculty of Medicine Charles University, Alej Svobody 80, 301 66 Pilsen, Czech Republic
| | - Jan Spicka
- Department of Laboratory Genetics, Laboratory Diagnostics, Faculty Hospital Královské Vinohrady, Srobarova 50, 100 34 Prague 10, Czech Republic (V.B.)
| | - Rafal Matkowski
- Cellpeutics Sp. z o.o., Duńska 9,54-424 Wrocław, Poland
- Department of Oncology, Wroclaw Medical University, Wybrzeże Ludwika Pasteura 1, 50-367 Wrocław, Poland and Wroclaw Comprehensive Cancer Center, Plac Ludwika Hirszfelda 12, 53-413 Wrocław, Poland
| | - Marcin Jedryka
- Cellpeutics Sp. z o.o., Duńska 9,54-424 Wrocław, Poland
- Department of Oncology, Wroclaw Medical University, Wybrzeże Ludwika Pasteura 1, 50-367 Wrocław, Poland and Wroclaw Comprehensive Cancer Center, Plac Ludwika Hirszfelda 12, 53-413 Wrocław, Poland
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynecology Ospedale Policlinico San Martino Genoa, Italy Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) University of Genoa Genoa, Italy Academic Unit of Gynecology and Obstetrics University of Genoa, 16 132 Genoa, Italy
| | - Vladimir Bobek
- Department of Laboratory Genetics, Laboratory Diagnostics, Faculty Hospital Královské Vinohrady, Srobarova 50, 100 34 Prague 10, Czech Republic (V.B.)
- Department of Oncology, Wroclaw Medical University, Wybrzeże Ludwika Pasteura 1, 50-367 Wrocław, Poland and Wroclaw Comprehensive Cancer Center, Plac Ludwika Hirszfelda 12, 53-413 Wrocław, Poland
- Department of Histology and Embryology, Wroclaw Medical University, L. Pasteur 1, 503 67 Wroclaw, Poland
- Department of Thoracic Surgery, Krajská zdravotní a.s. Hospital, 41100 Ústí nad Labem, Czech Republic
- 3rd Department of Surgery University Hospital FN Motol and 1st Faculty of Medicine Charles University, V Uvalu 84, 150 06 Prague 5, Czech Republic
| | - Katarina Kolostova
- Department of Laboratory Genetics, Laboratory Diagnostics, Faculty Hospital Královské Vinohrady, Srobarova 50, 100 34 Prague 10, Czech Republic (V.B.)
- Department of Oncology, Wroclaw Medical University, Wybrzeże Ludwika Pasteura 1, 50-367 Wrocław, Poland and Wroclaw Comprehensive Cancer Center, Plac Ludwika Hirszfelda 12, 53-413 Wrocław, Poland
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Kızılay F, Şimşir A, Nazlı O. Management of ureteral endometriosis and review of the literature. Turk J Urol 2018; 45:S166-S169. [PMID: 33120006 DOI: 10.5152/tud.2018.21605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 03/30/2018] [Indexed: 11/22/2022]
Abstract
Endometriosis can affect 10-15% of the women in their reproductive age and it is characterized with the presence of the functional endometrium tissue outside the uterine cavity. Up to 10% of the cases with urinary system endometriosis may involve the ureter. Left distal ureter is the most common site of involvement. The differentiation between intrinsic and extrinsic endometriosis is very substantial for the selection and application of definitive treatment. Medical and surgical treatment alternatives are available for endometriosis management and histopathologic examination is required for definitive diagnosis. In this case report, a 33-year-old patient underwent segmental ureter excision and ureteroureteral anastomosis due to endometriosis causing obstruction in the left distal ureter. The operation was performed through a left Gibson incision and a 6 Fr double J stent was implanted in the ureter. The stent was removed after 4 weeks and the control magnetic resonance imaging-urography was performed at 3 months postoperatively. Obstruction and hydroureteronephrosis were observed to be completely regressed in control. If there is no other obvious etiology for the presence of unilateral hydroureteronephrosis in women in their reproductive age, the diagnosis of endometriosis should be considered.
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Affiliation(s)
- Fuat Kızılay
- Department of Urology, Ege University School of Medicine, İzmir, Turkey
| | - Adnan Şimşir
- Department of Urology, Ege University School of Medicine, İzmir, Turkey
| | - Oktay Nazlı
- Department of Urology, Ege University School of Medicine, İzmir, Turkey
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Li F, Alderman MH, Tal A, Mamillapalli R, Coolidge A, Hufnagel D, Wang Z, Neisani E, Gidicsin S, Krikun G, Taylor HS. Hematogenous Dissemination of Mesenchymal Stem Cells from Endometriosis. Stem Cells 2018; 36:881-890. [PMID: 29450941 PMCID: PMC5992028 DOI: 10.1002/stem.2804] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 12/22/2017] [Accepted: 01/19/2018] [Indexed: 12/31/2022]
Abstract
Endometriosis is ectopic growth of endometrial tissue traditionally thought to arise through retrograde menstruation. We aimed to determine if cells derived from endometriosis could enter vascular circulation and lead to hematogenous dissemination. Experimental endometriosis was established by transplanting endometrial tissue from DsRed+ mice into the peritoneal cavity of DsRed- mice. Using flow cytometry, we identified DsRed+ cells in blood of animals with endometriosis. The circulating donor cells expressed CXCR4 and mesenchymal stem cell (MSC) biomarkers, but not hematopoietic stem cell markers. Nearly all the circulating endometrial stem cells originated from endometriosis rather than from the uterus. Cells expressing DsRed, CXCR4, and MSCs markers were identified in the peritoneal wall and surrounding vessels of recipient mice, contributing to both endometriosis and angiogenesis. Cells originating in endometriosis lesions migrated and implanted in lung tissue and displayed makers of differentiation, indicating retained multipotency. In vitro these cells demonstrated multipotency and were able to differentiate into adipogenic, osteogenic, and chondrogenic lineages. Endometriosis lesions also expressed high levels of CXCL12, the CXCR4 receptor ligand. Serum CXCL12 levels were greater than in sham control mice. In humans with endometriosis, serum CXCL12 levels were significantly higher than controls, suggesting that the CXCL12/CXCR4 axis is operational in women with spontaneous endometriosis as well. Stem cells, rather than differentiated cells from endometriosis, enter the circulation in response to CXCL12. We identify an endometriosis-derived stem cell population, a potential mechanism of dissemination of this disease and a potential target for treatment of endometriosis. Stem Cells 2018;36:881-890.
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Affiliation(s)
- Fei Li
- Department of Obstetrics and Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Myles H. Alderman
- Department of Obstetrics and Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Aya Tal
- Department of Obstetrics and Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Ramanaiah Mamillapalli
- Department of Obstetrics and Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Alexis Coolidge
- Department of Obstetrics and Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Demetra Hufnagel
- Department of Obstetrics and Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Zhihao Wang
- Department of Obstetrics and Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Elham Neisani
- Department of Obstetrics and Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Stephanie Gidicsin
- Department of Obstetrics and Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Graciela Krikun
- Department of Obstetrics and Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Hugh S. Taylor
- Department of Obstetrics and Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
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9
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Soave I, Occhiali T, Wenger JM, Pluchino N, Caserta D, Marci R. Endometriosis and food habits: Can diet make the difference? JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2018. [DOI: 10.1177/2284026518773212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Endometriosis is a chronic, inflammatory, estrogenic-dependent disease characterized by the presence of endometrial glands outside the uterine cavity, affecting approximately 2%–10% of women in reproductive age and 30%–50% of women in general. Despite the high prevalence of the disease, not much is known about etiology, possible risk factors, and an adequate and satisfactory therapy. In the past years, many studies have focused on food intake (nutrients and food groups) and on its possible correlation with endometriosis, demonstrating how diet could be identified as a possible risk factor. Comprehensive searches in the largest medical information databases (Medline-PubMed, Embase, Lilacs, and Cochrane Library) were conducted using the Medical Subject Heading terms “diet,” “food,” “nutrition,” “fatty acids,” vitamins,” “fruit,” “vegetables,” “coffee,” “caffeine,” “fish,” “soy food,” “dairy products,” “tea,” “curcumin” combined with “endometriosis.” Purpose of this review is to revise the literature, in order to determine potential modifiable risk factors of the disease.
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Affiliation(s)
- Ilaria Soave
- Department of Medical and Surgical Sciences and Translational Medicine, Sant’Andrea Hospital, Faculty of Medicine and Psychology, University of Rome “Sapienza,” Rome, Italy
| | | | - Jean-Marie Wenger
- Department of Obstetrics and Gynecology, University Hospital of Geneva, Geneva, Switzerland
| | - Nicola Pluchino
- Department of Obstetrics and Gynecology, University Hospital of Geneva, Geneva, Switzerland
| | - Donatella Caserta
- Department of Medical and Surgical Sciences and Translational Medicine, Sant’Andrea Hospital, Faculty of Medicine and Psychology, University of Rome “Sapienza,” Rome, Italy
| | - Roberto Marci
- Department of Obstetrics and Gynecology, University Hospital of Geneva, Geneva, Switzerland
- Department of Morphology, Surgery and Experimental Medicine, Section of Gynecology and Obstetrics, University of Ferrara, Ferrara, Italy
- WHO/RHR, Department of Reproductive Health and Research, Geneva, Switzerland
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10
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Pluchino N, Mamillapalli R, Moridi I, Tal R, Taylor HS. G-Protein-Coupled Receptor CXCR7 Is Overexpressed in Human and Murine Endometriosis. Reprod Sci 2018; 25:1168-1174. [PMID: 29587613 DOI: 10.1177/1933719118766256] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Endometriosis is a chronic inflammatory disease. Dysfunctional regulation of chemokines and chemokine receptors is a crucial aspect of endometriosis pathogenesis. Chemokine G-protein-coupled receptors (GPCRs) are important drug targets that regulate inflammation and immunity. Recently, CXCR7, a C-X-C motif containing GPCR, has been identified as a receptor for chemokine ligand CXCL12, one of the best characterized chemokines for cell trafficking, angiogenesis, and cell proliferation in cancer and inflammation. Here, we investigated the expression and localization of CXCR7 in human endometriosis and a murine model of the disease. Normal endometrial epithelium and stroma showed undetectable or very low expression of CXCR7, without any significant changes across phases of the menstrual cycle in humans. CXCR7 is significantly upregulated in endometriosis, showing higher staining in glands and in associated vessels. The mouse model recapitulated the human findings. In conclusion, overexpression of CXCR7 in different cellular populations of endometriosis microenvironment may play a role in the pathogenesis and represent a novel target for treatment.
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Affiliation(s)
- Nicola Pluchino
- 1 Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Ramanaiah Mamillapalli
- 1 Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Irene Moridi
- 1 Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Reshef Tal
- 1 Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Hugh S Taylor
- 1 Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
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Vitale SG, Capriglione S, Peterlunger I, La Rosa VL, Vitagliano A, Noventa M, Valenti G, Sapia F, Angioli R, Lopez S, Sarpietro G, Rossetti D, Zito G. The Role of Oxidative Stress and Membrane Transport Systems during Endometriosis: A Fresh Look at a Busy Corner. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2018; 2018:7924021. [PMID: 29743986 PMCID: PMC5883985 DOI: 10.1155/2018/7924021] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 02/18/2018] [Indexed: 11/17/2022]
Abstract
Endometriosis is a condition characterized by the presence of endometrial tissue outside the uterine cavity, leading to a chronic inflammatory reaction. It is one of the most widespread gynecological diseases with a 10-15% prevalence in the general female population, rising up to 30-45% in patients with infertility. Although it was first described in 1860, its etiology and pathogenesis are still unclear. It is now accepted that inflammation plays a central role in the development and progression of endometriosis. In particular, it is marked by an inflammatory process associated with the overproduction of an array of inflammatory mediators such as prostaglandins, metalloproteinases, cytokines, and chemokines. In addition, the growth and adhesion of endometrial cells in the peritoneal cavity due to reactive oxygen species (ROS) and free radicals lead to disease onset, its ensuing symptoms-among which pain and infertility. The aim of our review is to evaluate the role of oxidative stress and ROS in the pathogenesis of endometriosis and the efficacy of antioxidant therapy in the treatment and mitigation of its symptoms.
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Affiliation(s)
- Salvatore Giovanni Vitale
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Stella Capriglione
- Department of Obstetrics and Gynecology, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Isabel Peterlunger
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149 Trieste, Italy
| | - Valentina Lucia La Rosa
- Unit of Psychodiagnostics and Clinical Psychology, University of Catania, Via Santa Sofia 78, 95124 Catania, Italy
| | - Amerigo Vitagliano
- Department of Woman and Child Health, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
| | - Marco Noventa
- Department of Woman and Child Health, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
| | - Gaetano Valenti
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Via Santa Sofia 78, 95124 Catania, Italy
| | - Fabrizio Sapia
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Via Santa Sofia 78, 95124 Catania, Italy
| | - Roberto Angioli
- Department of Obstetrics and Gynecology, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Salvatore Lopez
- Department of Obstetrics and Gynecology, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Giuseppe Sarpietro
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Via Santa Sofia 78, 95124 Catania, Italy
| | - Diego Rossetti
- Unit of Gynecology and Obstetrics, Desenzano del Garda Hospital, Section of Gavardo, Via A. Gosa 74, 25085 Gavardo, Italy
| | - Gabriella Zito
- Department of Obstetrics and Gynecology, Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, Via dell'Istria 65/1, 34137 Trieste, Italy
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12
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Laganà AS, Vitale SG, Salmeri FM, Triolo O, Ban Frangež H, Vrtačnik-Bokal E, Stojanovska L, Apostolopoulos V, Granese R, Sofo V. Unus pro omnibus, omnes pro uno: A novel, evidence-based, unifying theory for the pathogenesis of endometriosis. Med Hypotheses 2017; 103:10-20. [DOI: 10.1016/j.mehy.2017.03.032] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 03/21/2017] [Indexed: 01/17/2023]
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Abstract
Endometriosis is defined by the presence of endometrial ectopia. Multiple hypotheses have been postulated to explain the etiology of endometriosis to understand various clinical evidences. The etiology of endometriosis is still unclear.The primary question to understanding the etiology of endometrial ectopia (endometriosis) is determining the origin of eutopic (normally cited) endometrium.According to the new theory, primordial germ cells migrate from hypoblast (yolk sac close to the allantois) to the gonadal ridges. The gonadal ridges which composed of primordial germ cells derive to the: eutopic endometrium, ovary, ovarian ligament and ligamentum teres uteri.There are 2 principal processes in uterine organogenesis: the intersection of gonadal ridges with mesonephral ducts to form the uterine folds with an endometrial cavity and the fusion of the both uterine folds together to form the unicavital (normal) uterus. In the uterine folds there are closer cell-to-cell communications, polypotential germ cells differentiate and grow into myometrium and endometrial layers.Some of the polypotential germ cells fail to reach the ridges and stay in the peritoneal cavity, where they may be transforming into external endometrial heterotopies.The main insight in the etiology of endometriosis is polypotential germ cells origin, which may explain its potency, pathogenesis and expansion.
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Affiliation(s)
- Zograb Makiyan
- a Department of Operative Gynaecology , Federal State Scientific Centre of Obstetrics, Gynaecology and Perinatology after V.I. Kulakov , Moscow , Russia
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Laganà AS, Salmeri FM, Vitale SG, Triolo O, Götte M. Stem Cell Trafficking During Endometriosis: May Epigenetics Play a Pivotal Role? Reprod Sci 2017; 25:978-979. [PMID: 28100109 DOI: 10.1177/1933719116687661] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Antonio Simone Laganà
- 1 Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi," University of Messina, Messina, Italy
| | - Francesca Maria Salmeri
- 2 Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Salvatore Giovanni Vitale
- 1 Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi," University of Messina, Messina, Italy
| | - Onofrio Triolo
- 1 Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi," University of Messina, Messina, Italy
| | - Martin Götte
- 3 Department of Gynecology and Obstetrics, Münster University Hospital, Münster, Germany
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Yuan M, Li D, An M, Li Q, Zhang L, Wang G. Rediscovering peritoneal macrophages in a murine endometriosis model. Hum Reprod 2016; 32:94-102. [PMID: 27816922 DOI: 10.1093/humrep/dew274] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 09/26/2016] [Accepted: 10/20/2016] [Indexed: 12/31/2022] Open
Abstract
STUDY QUESTION What are the features of peritoneal macrophage subgroups and T helper cells in the development of murine endometriosis? SUMMARY ANSWER During the development of endometriosis in a murine model, large peritoneal macrophages (LPMs) and small peritoneal macrophages (SPMs) are polarized into M1 and M2 cells, respectively, and the proportions of T helper (Th) 1, Th17 and T regulatory (Treg) cells are increased. WHAT IS KNOWN ALREADY Numerous studies investigating the etiology and pathogenesis of endometriosis have focused on the polarization states of peritoneal macrophages in endometriosis models and patients, but the results are inconclusive. Further studies indicate that peritoneal macrophages are composed of two distinct subsets: LPMs and SPMs, although their roles in endometriosis are unknown. STUDY DESIGN, SIZE, DURATION This study involves a prospective and randomized experiment. Fifty C57BL/6 female mice were randomly allocated to five control and five experimental groups (n = 5/group) according to the presence or absence of transplantation. The transplant periods are 0.25, 3, 14, 28 and 42 days. PARTICIPANTS/MATERIALS, SETTING, METHODS C57BL/6 mice were utilized to establish an endometriosis model by i.p. injection of allogeneic endometrial segments. Dynamic changes of peritoneal macrophage subsets and polarization profiles were evaluated by flow cytometry (FCM). Macrophage morphology and density were assessed by cell counting under a microscope. Dynamic changes of Th1, Th2, Th17 and Treg cells were estimated by FCM. MAIN RESULTS AND THE ROLE OF CHANCE Peritoneal macrophages are composed of two distinct subsets: LPMs and SPMs. The proportion of SPMs increased immediately after peritoneal injection of endometrial tissues, whereas LPMs showed an opposite trend. Peritoneal macrophages differentiated into both M1 and M2 macrophages. The bidirectional polarization of macrophages was caused by the inverse trends of polarization of LPMs and SPMs. Consistently, the proportions of Th1, Th17 and Treg cells were all increased in mice with endometriosis. LARGE SCALE DATA N/A. LIMITATIONS, REASONS FOR CAUTION In this study, detection was only performed in a murine endometriosis model. Clinical data and more intervention experiments are required in understanding the roles of LPMs and SPMs in endometriosis. WIDER IMPLICATIONS OF THE FINDINGS The dramatic changes of LPMs and SPMs in proportion and polarization profiles clarified the varying differentiation states of peritoneal macrophages. In addition, LPMs and SPMs may play different roles in the pathogenesis of endometriosis in different stages of endometriosis. Therefore, the new classification should be included in future relevant basic and clinical studies on endometriosis. STUDY FUNDING/COMPETING INTERESTS This research was supported totally by grant 81270671 from the National Natural Science Foundation of China. The authors report no conflict of interest.
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Affiliation(s)
- Ming Yuan
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan 250012, People's Republic of China
| | - Dong Li
- Cryomedicine Laboratory, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan 250012, People's Republic of China
| | - Min An
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan 250012, People's Republic of China
| | - Qiuju Li
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan 250012, People's Republic of China
| | - Lu Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan 250012, People's Republic of China
| | - Guoyun Wang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan 250012, People's Republic of China
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Regulation of apoptotic pathways during endometriosis: from the molecular basis to the future perspectives. Arch Gynecol Obstet 2016; 294:897-904. [PMID: 27628753 DOI: 10.1007/s00404-016-4195-6] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 09/06/2016] [Indexed: 12/14/2022]
Abstract
PURPOSE Endometriosis is defined as the presence of endometrial-like endometrial cells, glands and stroma outside the uterus, causing a strong inflammatory-like microenvironment in the affected tissue. This may provoke a breakdown in the peritoneal cavity homeostasis, with the consequent processes of immune alteration, documented by peripheral mononuclear cells recruitment and secretion of inflammatory cytokines in early phases and of angiogenic and fibrogenic cytokines in the late stages of the disease. Considering the pivotal role of interaction between immune and endometriotic cells, in this paper, we aim to shed light about the role of apoptosis pathways in modulating the fine-regulated peritoneal microenvironment during endometriosis. METHODS Narrative overview, synthesizing the findings of literature retrieved from searches of computerized databases. RESULTS In normal conditions, endometriotic cells, refluxed through the fallopian tubes into the peritoneal cavity, should be attacked and removed by phagocytes and NK cells. During endometriosis, the breakdown of peritoneal homeostasis causes the failure of scavenging mechanisms, allowing the survival of endometriotic cells. The consequent so-called "immunoescaping" of endometriotic cells could be due, at least in part, to the reduction of apoptotic-mediated pathways previously described. CONCLUSION Considering the large amount of evidence retrieved from in vitro as well as in vivo models, the reduced apoptosis of endometriotic cells together with the increased apoptosis of peritoneal fluid mononuclear cells may address the peritoneal homeostasis to a permissive environment for the progression of the disease.
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Full-Thickness Excision versus Shaving by Laparoscopy for Intestinal Deep Infiltrating Endometriosis: Rationale and Potential Treatment Options. BIOMED RESEARCH INTERNATIONAL 2016; 2016:3617179. [PMID: 27579309 PMCID: PMC4989089 DOI: 10.1155/2016/3617179] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 04/08/2016] [Accepted: 07/18/2016] [Indexed: 01/16/2023]
Abstract
Endometriosis is defined as the presence of endometrial mucosa (glands and stroma) abnormally implanted in locations other than the uterine cavity. Deep infiltrating endometriosis (DIE) is considered the most aggressive presentation of the disease, penetrating more than 5 mm in affected tissues, and it is reported in approximately 20% of all women with endometriosis. DIE can cause a complete distortion of the pelvic anatomy and it mainly involves uterosacral ligaments, bladder, rectovaginal septum, rectum, and rectosigmoid colon. This review describes the state of the art in laparoscopic approach for DIE with a special interest in intestinal involvement, according to recent literature findings. Our attention has been focused particularly on full-thickness excision versus shaving technique in deep endometriosis intestinal involvement. Particularly, the aim of this paper is clarifying from the clinical and methodological points of view the best surgical treatment of deep intestinal endometriosis, since there is no standard of care in the literature and in different surgical settings. Indeed, this review tries to suggest when it is advisable to manage the full-thickness excision or the shaving technique, also analyzing perioperative management, main complications, and surgical outcomes.
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18
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Laganà AS, Salmeri FM, Triolo O, Vitale SG, Granese R, Sofo V. Comments on “rhTNFR:Fc Suppresses the Development of Endometriosis in a Mouse Model by Downregulating Cell Proliferation and Invasiveness”. Reprod Sci 2016; 25:983-984. [DOI: 10.1177/1933719116653838] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Antonio Simone Laganà
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood “G. Barresi,” University of Messina, Messina, Italy
| | - Francesca Maria Salmeri
- Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Onofrio Triolo
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood “G. Barresi,” University of Messina, Messina, Italy
| | - Salvatore Giovanni Vitale
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood “G. Barresi,” University of Messina, Messina, Italy
| | - Roberta Granese
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood “G. Barresi,” University of Messina, Messina, Italy
| | - Vincenza Sofo
- Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging, University of Messina, Messina, Italy
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19
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Nirgianakis K, Grandi G, McKinnon B, Bersinger N, Cagnacci A, Mueller M. Dienogest mediates midkine suppression in endometriosis. Hum Reprod 2016; 31:1981-6. [DOI: 10.1093/humrep/dew180] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 06/20/2016] [Indexed: 01/22/2023] Open
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20
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Maniglio P, Ricciardi E, Laganà AS, Triolo O, Caserta D. Epigenetic modifications of primordial reproductive tract: A common etiologic pathway for Mayer-Rokitansky-Kuster-Hauser Syndrome and endometriosis? Med Hypotheses 2016; 90:4-5. [DOI: 10.1016/j.mehy.2016.02.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 02/12/2016] [Accepted: 02/20/2016] [Indexed: 10/22/2022]
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21
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Calagna G, Perino A, Chianetta D, Vinti D, Triolo MM, Rimi C, Cucinella G, Agrusa A. Primary umbilical endometrioma: Analyzing the pathogenesis of endometriosis from an unusual localization. Taiwan J Obstet Gynecol 2016; 54:306-12. [PMID: 26166347 DOI: 10.1016/j.tjog.2014.03.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2014] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE This report presents a rare case of symptomatic primary umbilical endometriosis and reviews the literature on the topic with the aim to clarify some questions on the origin of endometriosis. CASE REPORT A 33-year-old woman with cyclic umbilical bleeding was found to have umbilical endometriosis. She had no history of pelvic or abdominal surgery. There was no past history of endometriosis or endometriosis-associated symptoms. An omphalectomy was performed after explorative laparoscopy to carefully inspect the abdominopelvic cavity and assess any coexisting pelvic endometriotic lesions. Histological examination confirmed the diagnosis of umbilical endometriosis. CONCLUSION Umbilical endometriosis is a rare but under-recognized phenomenon. Primary lesions are difficult to recognize, but probably represent an independent nosological entity. The possibility of endometriosis must be considered during the evaluation of an umbilical mass despite the absence of previous surgery. Complete excision and successive histology are highly recommended.
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Affiliation(s)
- Gloria Calagna
- Department of Obstetrics and Gynecology, University Hospital "P. Giaccone", Palermo, Italy.
| | - Antonino Perino
- Department of Obstetrics and Gynecology, University Hospital "P. Giaccone", Palermo, Italy
| | - Daniela Chianetta
- Department of General Surgery, Emergency and Organ Transplantation, University Hospital "P. Giaccone", Palermo, Italy
| | - Daniele Vinti
- Department of Obstetrics and Gynecology, University Hospital "P. Giaccone", Palermo, Italy
| | | | - Carlo Rimi
- Department of Pathological Anatomy, University Hospital "P. Giaccone", Palermo, Italy
| | - Gaspare Cucinella
- Department of Obstetrics and Gynecology, University Hospital "P. Giaccone", Palermo, Italy
| | - Antonino Agrusa
- Department of General Surgery, Emergency and Organ Transplantation, University Hospital "P. Giaccone", Palermo, Italy
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Ashrafi M, Sadatmahalleh SJ, Akhoond MR, Talebi M. Evaluation of Risk Factors Associated with Endometriosis in Infertile Women. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2016; 10:11-21. [PMID: 27123195 PMCID: PMC4845520 DOI: 10.22074/ijfs.2016.4763] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 06/07/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Endometriosis affects women's physical and mental wellbeing. Symptoms include dyspareunia, dysmenorrhea, pelvic pain, and infertility. The purpose of this study is to assess the correlation between some relevant factors and symptoms and risk of an endometriosis diagnosis in infertile women. MATERIALS AND METHODS A retrospective study of 1282 surgical patients in an infertility Institute, Iran between 2011 and 2013 were evaluated by laparoscopy. Of these, there were 341 infertile women with endometriosis (cases) and 332 infertile women with a normal pelvis (comparison group). Chi-square and t tests were used to compare these two groups. Logistic regression was done to build a prediction model for an endometriosis diagnosis. RESULTS Gravidity [odds ratio (OR): 0.8, confidence interval (CI): 0.6-0.9, P=0.01], parity (OR: 0.7, CI: 0.6-0.9, P=0.01), family history of endometriosis (OR: 4.9, CI: 2.1-11.3, P<0.001), history of galactorrhea (OR: 2.3, CI: 1.5-3.5, P=0.01), history of pelvic surgery (OR: 1.9, CI: 1.3-2.7, P<0.001), and shorter menstrual cycle length (OR: 0.9, CI: 0.9-0.9, P=0.04) were associated with endometriosis. Duration of natural menstruation and age of menarche were not correlated with subsequent risk of endometriosis (P>0.05). Fatigue, diarrhea, constipation, dysmenorrhea, dyspareunia, pelvic pain and premenstrual spotting were more significant among late-stage endometriosis patients than in those with early-stage endometriosis and more prevalent among patients with endometriosis than that of the comparison group. In the logistic regression model, gravidity, family history of endometriosis, history of galactorrhea, history of pelvic surgery, dysmenorrhoea, pelvic pain, dysparaunia, premenstrual spotting, fatigue, and diarrhea were significantly associated with endometriosis. However, the number of pregnancies was negatively related to endometriosis. CONCLUSION Endometriosis is a considerable public health issue because it affects many women and is associated with the significant morbidity. In this study, we built a prediction model which can be used to predict the risk of endometriosis in infertile women.
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Affiliation(s)
- Mahnaz Ashrafi
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran; Department of Obstetrics and Gynecology, Faculty of Medicine, Iran University of Medical Science, Tehran, Iran
| | - Shahideh Jahanian Sadatmahalleh
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran; Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mohammad Reza Akhoond
- Department of Statistics, Mathematical Science and Computer Faculty, Shahid Chamran University, Ahwaz, Iran
| | - Mehrak Talebi
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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Guan YT, Huang YQ, Wu JB, Deng ZQ, Wang Y, Lai ZY, Wang HB, Sun XX, Zhu YL, Du MM, Zhu LY, Chen LX, Wang LW. Overexpression of chloride channel-3 is associated with the increased migration and invasion ability of ectopic endometrial cells from patients with endometriosis. Hum Reprod 2016; 31:986-98. [PMID: 26965430 DOI: 10.1093/humrep/dew034] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 02/07/2016] [Indexed: 12/21/2022] Open
Abstract
STUDY QUESTION Is chloride channel-3 (ClC-3) involved in regulating the biological behavior of endometrial stromal cells (ESCs)? SUMMARY ANSWER ClC-3 promotes endometriotic cell migration and invasion. WHAT IS KNOWN ALREADY ClC-3 plays a significant role in the migration and invasion of various kinds of cells. STUDY DESIGN, SIZE, DURATION An ITALIC! in vitro investigation of the effect of ClC-3 on the migration and invasion of ectopic ESCs from patients with endometriosis. PARTICIPANTS/MATERIALS, SETTING, METHODS The ectopic and eutopic endometrial samples from 43 female patients with endometriosis and the endometrial samples from 39 non-endometriotic female patients were collected. Primary cells from these samples were isolated and cultured. Real-time RT-PCR, immunohistochemistry and western blot were used to detect the expression of ClC-3 and matrix metalloproteinase 9 (MMP-9). Small interfering RNA (siRNA) technology was employed to knock down ClC-3 expression. The migration and invasion ability of ESCs was measured by the transwell assay with uncoated or Matrigel-coated membranes. MAIN RESULTS AND THE ROLE OF CHANCE The expression of ClC-3 mRNA and proteins was significantly up-regulated in the ectopic tissues from endometriotic patients, while that in the eutopic endometrial tissues of the same patients did not significantly differ from that in non-endometriotic patients. The migration and invasion ability and MMP-9 expression was increased in the ESCs from ectopic endometrial tissues. The knockdown of ClC-3 expression by ClC-3 siRNA inhibited ESC migration and invasion and attenuated the expression of MMP-9. ClC-3 expression level was well-correlated to the clinical characteristics and symptoms of endometriosis patients, including infertility, dysmenorrhea, chronic pelvic pain, dyspareunia and diameter of endometriosis lesion. LIMITATIONS, REASONS FOR CAUTION Further studies are needed to examine the regulatory mechanism of estrogen on ClC-3 expression of ESCs. WIDER IMPLICATIONS OF THE FINDINGS ClC-3 is involved in the migration and invasion processes of ESCs and can regulate MMP-9 expression. Up-regulation of ClC-3 expression may contribute to endometriosis development by regulating MMP-9 expression. STUDY FUNDING/COMPETING INTERESTS This work was supported by the National Natural Science Foundation of China (81173064, 81272223, 81273539), the Ministry of Education of China (20124401110009), the Natural Science Foundation of Guangdong Province (S2011010001589) and the Science and Technology Programs of Guangdong (2013B051000059), Guangzhou (2013J500015) and Dongguan (2011108102006). The authors have no conflict of interest.
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Affiliation(s)
- Yu-tao Guan
- Department of Pharmacology, Medical College, Jinan University, Guangzhou 510632, China Department of Pathophysiology, Medical College, Jinan University, Guangzhou, China
| | - Yan-qing Huang
- Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Jia-bao Wu
- Department of Pharmacology, Medical College, Jinan University, Guangzhou 510632, China
| | - Zhi-qin Deng
- Department of Pharmacology, Medical College, Jinan University, Guangzhou 510632, China Department of Pathophysiology, Medical College, Jinan University, Guangzhou, China
| | - Yuan Wang
- Department of Physiology, Medical College, Jinan University, Guangzhou 510632, China
| | - Zhou-yi Lai
- Department of Physiology, Medical College, Jinan University, Guangzhou 510632, China
| | - Hai-bo Wang
- Department of Pharmacology, Medical College, Jinan University, Guangzhou 510632, China
| | - Xiao-xue Sun
- Department of Physiology, Medical College, Jinan University, Guangzhou 510632, China
| | - Ya-li Zhu
- Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Miao-miao Du
- Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Lin-yan Zhu
- Department of Pharmacology, Medical College, Jinan University, Guangzhou 510632, China
| | - Li-xin Chen
- Department of Pharmacology, Medical College, Jinan University, Guangzhou 510632, China Department of Pathophysiology, Medical College, Jinan University, Guangzhou, China
| | - Li-wei Wang
- Department of Pathophysiology, Medical College, Jinan University, Guangzhou, China Department of Physiology, Medical College, Jinan University, Guangzhou 510632, China
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Borrelli GM, Abrão MS, Taube ET, Darb-Esfahani S, Köhler C, Chiantera V, Mechsner S. (Partial) Loss of BAF250a (ARID1A) in rectovaginal deep-infiltrating endometriosis, endometriomas and involved pelvic sentinel lymph nodes. Mol Hum Reprod 2016; 22:329-37. [PMID: 26832958 DOI: 10.1093/molehr/gaw009] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 01/18/2016] [Indexed: 01/01/2023] Open
Abstract
STUDY HYPOTHESIS Loss of protein BAF250a (ARID1A) expression is present in women with rectovaginal deep-infiltrating endometriosis (DIE) and endometriosis affecting the pelvic sentinel lymph nodes (PSLN). STUDY FINDING Partial loss of protein BAF250a was found in some of our patient samples, comprising all endometriosis entities, including rectovaginal DIE and endometriosis affecting the PSLN. WHAT IS KNOWN ALREADY Loss of BAF250a (BRG-associated factor 250a)/ARIDIA (AT-rich interactive domain 1A) protein expression was identified among endometriosis-associated ovarian carcinomas and ovarian endometriosis, and this phenomenon was described as a possible early event in the transformation of endometriosis into cancer. DIE affecting the bowel/rectovaginal site is the most aggressive presentation of endometriosis and its 'risk' of malignant transformation has not been studied so far. STUDY DESIGN, SAMPLES/MATERIALS, METHODS We evaluated the immunohistochemical expression of BAF250a protein in 70 samples from patients enrolled in this study who were surgically treated at a tertiary center, university Hospital. The samples submitted to investigation were from rectovaginal DIE (n= 25/30), endometriosis affecting the PSLN (n= 5/7), ovarian endometriosis (n= 20/20) and endometrium from patients without endometriosis used as controls (n= 20/20). MAIN RESULTS AND THE ROLE OF CHANCE Partial loss (i.e. in one tissue section some cells stained positive for BAF250a while other cells, usually an adjacent group, were negative) of BAF250a protein was identified in 36% (9/25) of rectovaginal DIE samples, 40% (2/5) of endometriosis lesions involving the PSLN, 30% (6/20) of endometriomas, and also in 25% (5/20) of endometrium from controls. We found no statistical correlation between occurrence of partial loss of BAF250a protein and the use or not of hormone medications (P = 0.106), cycle phase (P = 0.917) and stage of disease (P = 0.717). LIMITATIONS, REASONS FOR CAUTION We only found partial loss of BAF250a protein expression, and in a small population of women, with relatively high frequency in all benign tissues assessed in the present analysis. Therefore, this finding alone should not be correlated directly with the risk of malignant transformation in these lesions. WIDER IMPLICATIONS OF THE FINDINGS The occurrence of partial loss of BAF250a protein expression in women with rectovaginal DIE and endometriosis affecting the PSLN is described for the first time. The value of this finding as a predictor of malignant transformation in endometriosis must still be clarified and further studied in association with other molecular events, such as PTEN (phosphatase and tensin homolog) deletion and PIK3CA (phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha) mutation. We might then be able to identify in the future which patients with endometriosis are at higher risk of cancer. STUDY FUNDING AND COMPETING INTERESTS This study was supported by an internal Charité grant to the Endometriosis Research Center and the authors declare no conflicts of interest.
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Affiliation(s)
- G M Borrelli
- Clinic for Gynecology - Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Germany Department of Obstetrics and Gynecology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - M S Abrão
- Department of Obstetrics and Gynecology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - E T Taube
- Institute of Pathology, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - S Darb-Esfahani
- Institute of Pathology, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - C Köhler
- Clinic for Gynecology - Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Germany Department of Gynecology, Asklepios Klinik Harburg, Hamburg, Germany
| | - V Chiantera
- Clinic for Gynecology - Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - S Mechsner
- Clinic for Gynecology - Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Germany
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Mellado BH, Falcone ACM, Poli-Neto OB, Rosa E Silva JC, Nogueira AA, Candido-Dos-Reis FJ. Social isolation in women with endometriosis and chronic pelvic pain. Int J Gynaecol Obstet 2016; 133:199-201. [PMID: 26873129 DOI: 10.1016/j.ijgo.2015.08.024] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 07/19/2015] [Accepted: 12/22/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the perceptions of women with endometriosis and chronic pelvic pain regarding their social ties. METHODS A qualitative study was undertaken of women with chronic pelvic pain and endometriosis. Focus groups discussions among four to six participants were performed until saturation at the Clinics Hospital of Ribeirão Preto Medical School, Ribeirão Preto, southwest Brazil, between February 2013 and January 2014. Transcripts were analyzed according to the grounded theory approach and the emerging categories were coded using the WebQDA platform. RESULTS Six focus group discussions took place, with a total of 29 patients. Social isolation was the main emerging theme. Social isolation was associated with a lack of understanding about endometriosis symptoms and with resignation in face of recurrent pain episodes. Avoiding partner intimacy and isolation from family and friends were components of social isolation. CONCLUSION Women with endometriosis develop progressive social isolation after the onset of chronic pelvic pain. This finding is important for the multidisciplinary management of the disease.
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Affiliation(s)
- Bruna H Mellado
- Department of Gynecology and Obstetrics of Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil
| | - Ananda C M Falcone
- Department of Gynecology and Obstetrics of Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil
| | - Omero B Poli-Neto
- Department of Gynecology and Obstetrics of Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil
| | - Julio C Rosa E Silva
- Department of Gynecology and Obstetrics of Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil
| | - Antonio A Nogueira
- Department of Gynecology and Obstetrics of Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil
| | - Francisco J Candido-Dos-Reis
- Department of Gynecology and Obstetrics of Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil.
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26
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Laganà AS, Triolo O, Salmeri FM, Granese R, Palmara VI, Ban Frangež H, Vrtčnik Bokal E, Sofo V. Natural Killer T cell subsets in eutopic and ectopic endometrium: a fresh look to a busy corner. Arch Gynecol Obstet 2016; 293:941-9. [DOI: 10.1007/s00404-015-4004-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 12/21/2015] [Indexed: 12/21/2022]
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27
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Farkhat KN, Savilova AM, Makiyan ZN, Adamyan LV. The role of stem cells in the pathogenesis of endometriosis (а review). ACTA ACUST UNITED AC 2016. [DOI: 10.17116/repro201622120-27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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28
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Laganà AS, Giacobbe V, Triolo O, Granese R, Ban Frangež H, Vrtačnik-Bokal E, Ietto C, Palmara VI. Dienogest as preoperative treatment of submucous myomas for hysteroscopic surgery: a prospective, randomized study. Gynecol Endocrinol 2016; 32:408-11. [PMID: 26743136 DOI: 10.3109/09513590.2015.1128409] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The aim of this single-center, prospective, randomized, parallel-group study was to compare Dienogest and Danazol as endometrial preparation in patients who have to undergo hysteroscopic surgery for submucous myomas. We enrolled 80 consecutive eligible patients, in reproductive age, affected by submucous myomas. Pre- and posttreatment characterization of endometrium was performed by hysteroscopic visual observation and histologic confirmation. The enrolled patients were randomly assigned to two groups: 40 were treated with 2 mg of Dienogest/die, 40 with 100 mg of Danazol/die, both orally for 5 weeks, starting on day 1 of menstruation. Posttreatment comparison of endometrial patterns showed a significant more marked effect of Dienogest, respect to Danazol, in atrophying endometrium ("normotrophic non-responders" versus "hypotrophic"-"atrophic", p = 0.028). Intraoperative data showed no significant difference between the two groups for cervical dilatation time (p = 0.326), while in the Dienogest group, we found a significant reduction of operative time (p = 0.001), infusion volume (p = 0.001), and severity of bleeding (p = 0.042). Moreover, Dienogest caused less side effects (p = 0.008). According to our data analysis, Dienogest, respect to Danazol, is more effective for the preparation of the endometrium in patients who have to undergo hysteroscopic surgery for submucous myomas, and causes less side effects.
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Affiliation(s)
- Antonio Simone Laganà
- a Department of Human Pathology in Adulthood and Childhood "G. Barresi" , Unit of Gynecology and Obstetrics, University of Messina , Messina , Italy and
| | - Valentina Giacobbe
- a Department of Human Pathology in Adulthood and Childhood "G. Barresi" , Unit of Gynecology and Obstetrics, University of Messina , Messina , Italy and
| | - Onofrio Triolo
- a Department of Human Pathology in Adulthood and Childhood "G. Barresi" , Unit of Gynecology and Obstetrics, University of Messina , Messina , Italy and
| | - Roberta Granese
- a Department of Human Pathology in Adulthood and Childhood "G. Barresi" , Unit of Gynecology and Obstetrics, University of Messina , Messina , Italy and
| | - Helena Ban Frangež
- b Department of Reproduction , University Medical Center Ljubljana , Ljubljana , Slovenia
| | - Eda Vrtačnik-Bokal
- b Department of Reproduction , University Medical Center Ljubljana , Ljubljana , Slovenia
| | - Chiara Ietto
- a Department of Human Pathology in Adulthood and Childhood "G. Barresi" , Unit of Gynecology and Obstetrics, University of Messina , Messina , Italy and
| | - Vittorio Italo Palmara
- a Department of Human Pathology in Adulthood and Childhood "G. Barresi" , Unit of Gynecology and Obstetrics, University of Messina , Messina , Italy and
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29
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Laganà AS, Sofo V, Salmeri FM, Palmara VI, Triolo O, Terzić MM, Patrelli TS, Lukanovic A, Bokal EV, Santoro G. Oxidative Stress during Ovarian Torsion in Pediatric and Adolescent Patients: Changing The Perspective of The Disease. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2015; 9:416-23. [PMID: 26985329 PMCID: PMC4793162 DOI: 10.22074/ijfs.2015.4598] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 09/01/2015] [Indexed: 12/20/2022]
Abstract
Among the different causes of gynecological acute pelvic pain, ovarian torsion represents a surgical emergency. It is a rare case in the pediatric/adolescent aged group
that must be included in the differential diagnosis of any girl with abdominal pain or
pelvic/abdominal mass. Current recommendations suggest that laparoscopic detorsion should be performed in order to preserve the integrity of the ovaries and fertility,
although oophoropexy may be considered in case of severe necrosis. Nevertheless,
maintaining the circulation of the ovary after detorsion deteriorates the tissue injury
and leads to a pathologic process called ischaemia/reperfusion (I/R) injury, which is
characterized by oxidative stress. During the detorsion process, an excess amount of
molecular oxygen is supplied to the tissues, and reactive species of oxygen (ROS)
such as superoxide radical (O2-), hydrogen peroxide (H2O2), hydroxyl radical (OH•),
as well as reactive nitrogen species (RNS) are produced in excess. ROS, RNS and
their toxic products cause DNA damage and lipid peroxidation in the cellular and
mitochondrial membranes, leading to cell death. In spite of attention on this topic,
currently there is no shared and clear evidence about the use of anti-inflammatory
and antioxidant agents to prevent I/R damage after laparoscopic ovarian detorsion.
Considering this element, future research should aim to develop shared protocols for
the clinical use (route of application, dosage and time of application) of antioxidants
after laparoscopic management of this condition.
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Affiliation(s)
- Antonio Simone Laganà
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood, G. Barresi, University of Messina, Messina, Italy
| | - Vincenza Sofo
- Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Francesca Maria Salmeri
- Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Vittorio Italo Palmara
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood, G. Barresi, University of Messina, Messina, Italy
| | - Onofrio Triolo
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood, G. Barresi, University of Messina, Messina, Italy
| | - Milan Milosav Terzić
- University of Belgrade, School of Medicine, Belgrade, Serbia; Clinic for Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, Serbia
| | | | - Adolf Lukanovic
- Department of Gynecology and Obstetrics, University Clinical Center, Ljubljana, Slovenia
| | - Eda Vrtcnik Bokal
- Department of Gynecology and Obstetrics, University Clinical Center, Ljubljana, Slovenia
| | - Giuseppe Santoro
- Department of Biomedical Sciences and Morpho-Functional Images, University of Messina, Messina, Italy
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Analysis of psychopathological comorbidity behind the common symptoms and signs of endometriosis. Eur J Obstet Gynecol Reprod Biol 2015; 194:30-3. [DOI: 10.1016/j.ejogrb.2015.08.015] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 07/21/2015] [Accepted: 08/06/2015] [Indexed: 01/04/2023]
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Hufnagel D, Li F, Cosar E, Krikun G, Taylor HS. The Role of Stem Cells in the Etiology and Pathophysiology of Endometriosis. Semin Reprod Med 2015; 33:333-40. [PMID: 26375413 DOI: 10.1055/s-0035-1564609] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Human endometrium is a dynamic organ that normally undergoes repetitive cyclic regeneration. To enable this rapid regeneration, it is not surprising that the endometrium contains a reservoir of progenitor stem cells. However, this pool of cells that allows the growth of the endometrium also allows for unrestrained growth that can reach beyond the endometrium. In this review, we will address the role of stem cells in endometriosis. Recent characterization of stem cell populations within human endometrium has opened the possibility of understanding their physiologic as well as their pathologic roles. While stem cells are critical to the cyclic regeneration of a healthy endometrium, we have shown that both endometrium-derived and bone marrow-derived stem cells can migrate to ectopic sites and contribute to the development of endometriosis. Furthermore, endometriosis interferes with the normal stem cell trafficking to the uterus that is necessary for endometrial growth and repair. Altered stem cell mobility and engraftment characterize this disease.
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Affiliation(s)
- Demetra Hufnagel
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Fei Li
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Emine Cosar
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Graciela Krikun
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Hugh S Taylor
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
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Abstract
Endometriosis is a complex gynecologic condition affecting 6-10% of reproductive aged women and is a major cause of chronic pain and infertility. Mechanisms of disease pathogenesis are poorly understood. Considerable evidence supports the existence of a stem cell population in the endometrium which provides a physiologic source of regenerative endometrial cells, and multiple lines of evidence now support a key role for stem cells in the pathogenesis of endometriosis. In addition, new blood vessel formation is critical for the establishment and maintenance of endometriotic implants, a process in which endothelial progenitor cells may play an integral role. These new insights into disease pathogenesis present exciting opportunities to develop targeted and more effective therapeutic options in the management of this common and challenging disease.
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Affiliation(s)
- Amy S Dhesi
- Rutgers, New Jersey Medical School, Department of Obstetrics, Gynecology & Women's Health, Newark, NJ, USA
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33
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Hufnagel D, Li F, Cosar E, Krikun G, Taylor HS. The Role of Stem Cells in the Etiology and Pathophysiology of Endometriosis. Semin Reprod Med 2015. [PMID: 26375413 DOI: 10.1055/s-0035-1564609.the] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Abstract
Human endometrium is a dynamic organ that normally undergoes repetitive cyclic regeneration. To enable this rapid regeneration, it is not surprising that the endometrium contains a reservoir of progenitor stem cells. However, this pool of cells that allows the growth of the endometrium also allows for unrestrained growth that can reach beyond the endometrium. In this review, we will address the role of stem cells in endometriosis. Recent characterization of stem cell populations within human endometrium has opened the possibility of understanding their physiologic as well as their pathologic roles. While stem cells are critical to the cyclic regeneration of a healthy endometrium, we have shown that both endometrium-derived and bone marrow-derived stem cells can migrate to ectopic sites and contribute to the development of endometriosis. Furthermore, endometriosis interferes with the normal stem cell trafficking to the uterus that is necessary for endometrial growth and repair. Altered stem cell mobility and engraftment characterize this disease.
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Affiliation(s)
- Demetra Hufnagel
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Fei Li
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Emine Cosar
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Graciela Krikun
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Hugh S Taylor
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
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34
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Borrelli GM, Abrão MS, Taube ET, Darb-Esfahani S, Köhler C, Kaufmann AM, Chiantera V, Mechsner S. Immunohistochemical Investigation of Metastasis-Related Chemokines in Deep-Infiltrating Endometriosis and Compromised Pelvic Sentinel Lymph Nodes. Reprod Sci 2015; 22:1632-42. [PMID: 26169037 DOI: 10.1177/1933719115592711] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Endometriosis is a prevalent benign disease, despite sharing several similarities with malignancies, such as the possibility of lymphatic spread. In malignancies, chemokines play a sovereign role in the process of metastasis. Metastasis-related chemokine axes have not yet been assessed in deep-infiltrating endometriosis (DIE), and this investigation was the aim of our study. The expression of these chemokines was investigated by immunohistochemistry in rectovaginal DIE lesions and in matched pelvic sentinel lymph nodes (PSLNs) of patients with endometriosis (n = 27), and their expression in the eutopic endometrium (EE) of endometriosis-free women (n = 20) was used as controls. Their staining pattern in rectovaginal DIE, in endometriotic lesions affecting the PSLN as well as in the EE of patients without endometriosis was characterized for the first time. Overall, these chemokines were highly expressed in DIE and endometriosis in PSLN. Chemokines might be involved in the spread of endometriosis and should be further investigated.
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Affiliation(s)
- G M Borrelli
- Clinic for Gynecology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany Department of Obstetrics and Gynecology, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - M S Abrão
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - E T Taube
- Institute of Pathology, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - S Darb-Esfahani
- Institute of Pathology, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - C Köhler
- Clinic for Gynecology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany Department of Gynecology, Asklepios Klinik Harburg, Hamburg, Germany
| | - A M Kaufmann
- Clinic for Gynecology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - V Chiantera
- Clinic for Gynecology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - S Mechsner
- Clinic for Gynecology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
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35
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Sofo V, Götte M, Laganà AS, Salmeri FM, Triolo O, Sturlese E, Retto G, Alfa M, Granese R, Abrão MS. Correlation between dioxin and endometriosis: an epigenetic route to unravel the pathogenesis of the disease. Arch Gynecol Obstet 2015; 292:973-86. [DOI: 10.1007/s00404-015-3739-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 04/23/2015] [Indexed: 10/23/2022]
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36
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The pleiotropic effects of vitamin D in gynaecological and obstetric diseases: an overview on a hot topic. BIOMED RESEARCH INTERNATIONAL 2015; 2015:986281. [PMID: 26000308 PMCID: PMC4426767 DOI: 10.1155/2015/986281] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 01/17/2015] [Accepted: 01/20/2015] [Indexed: 12/31/2022]
Abstract
The traditionally recognized role of vitamin D consists in the regulation of bone metabolism and calcium-phosphorus homeostasis but recently a lot of in vitro and in vivo studies recognized several “noncalcemic” effects of vitamin D metabolites. Accumulating evidence suggests that the metabolic pathways of this vitamin may play a key role in the developing of gynaecological/obstetric diseases. VDR-mediated signalling pathways and vitamin D levels seem to (deeply) affect the risk of several gynaecological diseases, such as polycystic ovary syndrome (PCOS), endometriosis, and ovarian and even breast cancer. On the other hand, since also the maternal-fetal unit is under the influence of vitamin D, a breakdown in its homeostasis may underlie infertility, preeclampsia, and gestational diabetes mellitus (GDM). According to our literature review, the relationship between vitamin D and gynaecological/obstetric diseases must be replicated in future studies which could clarify the molecular machineries behind their development. We suggest that further investigation should take into account the different serum levels of this vitamin, the several actions which arise from the binding between it and its receptor (taking into account its possible polymorphism), and finally the interplay between vitamin D metabolism and other hormonal and metabolic pathways.
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Borrelli GM, Kaufmann AM, Abrão MS, Mechsner S. Addition of MCP-1 and MIP-3β to the IL-8 appraisal in peritoneal fluid enhances the probability of identifying women with endometriosis. J Reprod Immunol 2015; 109:66-73. [PMID: 25704572 DOI: 10.1016/j.jri.2015.01.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 12/22/2014] [Accepted: 01/08/2015] [Indexed: 02/07/2023]
Abstract
Chemokines have been associated with endometriosis. Our study was aimed at evaluating the levels of six chemokines--CXCL8 (IL-8), CXCL12 (SDF-1), CCL2 (MCP-1), CCL5 (RANTES), CCL19 (MIP-3β), and CCL21 (6-Ckine)--in the peritoneal fluid (PF) of patients with and controls without endometriosis by multiplexed cytokine assay. In this retrospective case-control study conducted at the Charité University Hospital, patients (n = 36) and controls (n = 27) were enrolled. The patients were separated into groups according to stage of the disease: I-II (n = 21), III-IV (n = 1 5), and according to clinical findings: peritoneal endometriosis (PE; n = 7), deep-infiltrating endometriosis (DIE) affecting the retrocervical area (n = 13) or the bowel/rectovaginal site (n = 14). The subjects were also separated according to the cycle phase: follicular (n = 14) or luteal (n = 8) and the previous use (n = 25) or not (n = 38) of hormones. PF was collected from all subjects (n = 63) consecutively during laparoscopy. The concentration of chemokines in the PF was assessed using Luminex(®) x-MAP(®) technology. Sensitivity and specificity were calculated. A model of multiple logistic regressions estimated the odds of endometriosis for each combination of the chemokines detected. We observed significantly higher concentrations of IL-8 (p < 0.001), MCP-1 (p = 0.014), and MIP-3β (p = 0.022) in the PF of women with endometriosis than in the controls. A joint evaluation revealed that elevated levels of the three chemokines had a positive endometriosis prediction value of 89.1%. The combined assessment of MCP-1, MIP-3β, and IL-8 concentration in PF improved the likelihood of identifying patients with endometriosis. Future studies should investigate this panel in peripheral blood samples.
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Affiliation(s)
- G M Borrelli
- Charité Universitätsmedizin Berlin - Gynecology Clinic, Campus Benjamin Franklin, Berlin, Germany; University of Sao Paulo, Faculty of Medicine - Department of Obstetrics and Gynecology, Brazil.
| | - A M Kaufmann
- Charité Universitätsmedizin Berlin - Gynecology Clinic, Campus Benjamin Franklin, Berlin, Germany
| | - M S Abrão
- University of Sao Paulo, Faculty of Medicine - Department of Obstetrics and Gynecology, Brazil
| | - S Mechsner
- Charité Universitätsmedizin Berlin - Gynecology Clinic, Campus Benjamin Franklin, Berlin, Germany.
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Djokovic D, Calhaz-Jorge C. Somatic stem cells and their dysfunction in endometriosis. Front Surg 2015; 1:51. [PMID: 25593975 PMCID: PMC4286966 DOI: 10.3389/fsurg.2014.00051] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 12/14/2014] [Indexed: 01/05/2023] Open
Abstract
Emerging evidence indicates that somatic stem cells (SSCs) of different types prominently contribute to endometrium-associated disorders such as endometriosis. We reviewed the pertinent studies available on PubMed, published in English language until December 2014 and focused on the involvement of SSCs in the pathogenesis of this common gynecological disease. A concise summary of the data obtained from in vitro experiments, animal models, and human tissue analyses provides insights into the SSC dysregulation in endometriotic lesions. In addition, a set of research results is presented supporting that SSC-targeting, in combination with hormonal therapy, may result in improved control of the disease, while a more in-depth characterization of endometriosis SSCs may contribute to the development of early-disease diagnostic tests with increased sensitivity and specificity. Key message: Seemingly essential for the establishment and progression of endometriotic lesions, dysregulated SSCs, and associated molecular alterations hold a promise as potential endometriosis markers and therapeutic targets.
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Affiliation(s)
- Dusan Djokovic
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa , Lisbon , Portugal ; Serviço de Obstetrícia e Ginecologia, Centro Hospitalar de Lisboa Ocidental, Hospital de São Francisco Xavier , Lisbon , Portugal
| | - Carlos Calhaz-Jorge
- Clínica Universitária de Obstetrícia e Ginecologia, Faculdade de Medicina, Universidade de Lisboa , Lisbon , Portugal ; Departamento de Obstetrícia, Ginecologia e Medicina da Reprodução, Centro Hospitalar de Lisboa Norte , Lisbon , Portugal
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39
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Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome: A historical perspective. Gene 2015; 555:33-40. [DOI: 10.1016/j.gene.2014.09.045] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 09/19/2014] [Accepted: 09/21/2014] [Indexed: 12/15/2022]
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40
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Adamyan LV, Farkhat KN, Makiyan ZN, Savilova AM. The external genital endometriosis: theories and molecular investigations (a review). ACTA ACUST UNITED AC 2015. [DOI: 10.17116/repro20152158-16] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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