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Yao J, Zhang LJ, Zhou Z, Hua MF. NK-92 cells activated by IL-2 inhibit the progression of endometriosis in vitro. J OBSTET GYNAECOL 2024; 44:2372682. [PMID: 39034630 DOI: 10.1080/01443615.2024.2372682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 06/20/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Interleukin (IL)-2 is a key cytokine capable of modulating the immune response by activating natural killer (NK) cells. This study was recruited to explore the therapeutic potential of IL-2-activated NK-92 cells in endometriosis in vitro. METHODS Ectopic endometrial stromal cells (EESCs) were isolated and co-cultured with IL-2-activated NK-92 cells at varying effector-to-target (E:T) ratios (1:0 [Control], 1:1, 1:3, and 1:9). The viability, cytotoxicity, and cell surface antigen expression of IL-2-activated NK-92 cells were assessed. The viability, apoptosis, invasion, and migration ability of EESCs co-cultured with NK-92 cells at different ratios were evaluated. The apoptosis-related proteins, invasion and migration-related proteins as well as MEK/ERK pathway were examined via western blot. Each experiment was repeated three times. RESULTS IL-2 activation enhanced NK-92 cytotoxicity in a concentration-dependent manner. Co-culturing EESCs with IL-2-activated NK-92 cells at E:T ratios of 1:1, 1:3, and 1:9 reduced EESC viability by 20%, 45%, and 70%, respectively, compared to the control group. Apoptosis rates in EESCs increased in correlation with the NK-92 cell proportion, with the highest rate observed at a 1:9 ratio. Moreover, EESC invasion and migration were significantly inhibited by IL-2-activated NK-92 cells, with a 60% reduction in invasion and a 50% decrease in migration at the 1:9 ratio. Besides, the MEK/ERK signalling pathway was down-regulated in EESCs by IL-2-activated NK-92 cells. CONCLUSION IL-2-activated NK-92 cells exhibit potent cytotoxic effects against EESCs. They promote EESC apoptosis and inhibit viability, invasion, and migration through modulating the MEK/ERK signalling pathway.
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Affiliation(s)
- Jun Yao
- Department of Gynecology, Lianyungang Maternal and Child Health Hospital, Lianyungang, Jiangsu, China
| | - Li-Jiao Zhang
- Department of Obstetrics, Lianyungang Maternal and Child Health Hospital, Lianyungang, Jiangsu, China
| | - Zhe Zhou
- Department of Gynecology, Lianyungang Maternal and Child Health Hospital, Lianyungang, Jiangsu, China
| | - Mao-Fang Hua
- Department of Gynecology, Lianyungang Maternal and Child Health Hospital, Lianyungang, Jiangsu, China
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García-Izquierdo L, Marín-Sánchez P, García-Peñarrubia P, Martínez-Esparza M. New Potential Pharmacological Options for Endometriosis Associated Pain. Int J Mol Sci 2024; 25:7068. [PMID: 39000175 PMCID: PMC11240985 DOI: 10.3390/ijms25137068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 06/22/2024] [Accepted: 06/26/2024] [Indexed: 07/16/2024] Open
Abstract
Endometriosis is a chronic inflammatory disorder characterized by the abnormal growth of endometrial-like tissue outside the uterine cavity, affecting 10-15% of women of reproductive age. Pain is the most common symptom. Treatment options include surgery, which has limited effectiveness and high recurrence rates, and pharmacotherapy. Hormonal therapies, commonly used for symptom management, can have side effects and contraceptive outcomes, contributing to the infertility associated with endometriosis, with pain and lesions often reappearing after treatment cessation. Among its etiological factors, immunological and inflammatory dysregulation plays a significant role, representing an interesting target for developing new therapeutic strategies. This review critically analyzes recent studies to provide an updated synthesis of ongoing research into potential new pharmacotherapies focusing on lesion progression, pain relief, and improving quality of life. Immunotherapy, natural anti-inflammatory and antioxidant compounds and drug repurposing show promise in addressing the limitations of current treatments by targeting immunological factors, potentially offering non-invasive solutions for managing pain and infertility in endometriosis. Promising results have been obtained from in vitro and animal model studies, but clinical trials are still limited. More effort is needed to translate these findings into clinical practice to effectively reduce disease progression, alleviate pain symptoms and preserve the reproductive capacity, improving patients' overall wellbeing.
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Affiliation(s)
- Laura García-Izquierdo
- Department of Biochemistry, Molecular Biology (B) and Immunology, Faculty of Medicine, Regional Campus of International Excellence "Campus Mare Nostrum", University of Murcia and Biomedical Research Institute of Murcia (IMIB), 30120 Murcia, Spain
| | - Pilar Marín-Sánchez
- Department of Gynaecology and Obstetrics, Hospital General Universitario Santa Lucía, University of Murcia and Biomedical Research Institute of Murcia (IMIB), 30120 Murcia, Spain
| | - Pilar García-Peñarrubia
- Department of Biochemistry, Molecular Biology (B) and Immunology, Faculty of Medicine, Regional Campus of International Excellence "Campus Mare Nostrum", University of Murcia and Biomedical Research Institute of Murcia (IMIB), 30120 Murcia, Spain
| | - María Martínez-Esparza
- Department of Biochemistry, Molecular Biology (B) and Immunology, Faculty of Medicine, Regional Campus of International Excellence "Campus Mare Nostrum", University of Murcia and Biomedical Research Institute of Murcia (IMIB), 30120 Murcia, Spain
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3
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Omidvar-Mehrabadi A, Ebrahimi F, Shahbazi M, Mohammadnia-Afrouzi M. Cytokine and chemokine profiles in women with endometriosis, polycystic ovary syndrome, and unexplained infertility. Cytokine 2024; 178:156588. [PMID: 38555853 DOI: 10.1016/j.cyto.2024.156588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/19/2024] [Accepted: 03/22/2024] [Indexed: 04/02/2024]
Abstract
Numerous factors (including immunological, congenital, hormonal, and morphological disorders) can lead to infertility. In this regard, 3 specific diseases associated with infertility are discussed in this review study (i.e., polycystic ovary syndrome [PCOS], endometriosis [EMS], and unexplained infertility [UI]). PCOS is a common endocrine disorder characterized by chronic low-grade inflammation, and EMS is a benign disease characterized by the presence of ectopic endometrial tissue. UI refers to couples who are unable to conceive for no known reason. Conception and pregnancy are significantly affected by the immune system; in this regard, chemokines and cytokines play important roles in the regulation of immune responses. Patients with PCOS, EMS, and UI have altered cytokine and chemokine profiles, suggesting that dysregulation of these molecules may contribute to infertility in these conditions. Accordingly, the issue of infertility is addressed in this review study, a condition that affects approximately 16% of couples worldwide.
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Affiliation(s)
| | - Fateme Ebrahimi
- Department of Immunology, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Mehdi Shahbazi
- Department of Immunology, School of Medicine, Babol University of Medical Sciences, Babol, Iran.
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Michel R, Hazimeh D, Saad EE, Olson SL, Musselman K, Elgindy E, Borahay MA. Common Beverage Consumption and Benign Gynecological Conditions. BEVERAGES (BASEL, SWITZERLAND) 2024; 10:33. [PMID: 38948304 PMCID: PMC11211953 DOI: 10.3390/beverages10020033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
The purpose of this article is to review the effects of four commonly consumed beverage types-sugar-sweetened beverages (SSBs), caffeinated beverages, green tea, and alcohol-on five common benign gynecological conditions: uterine fibroids, endometriosis, polycystic ovary syndrome (PCOS), anovulatory infertility, and primary dysmenorrhea (PD). Here we outline a plethora of research, highlighting studies that demonstrate possible associations between beverage intake and increased risk of certain gynecological conditions-such as SSBs and dysmenorrhea-as well as studies that demonstrate a possible protective effect of beverage against risk of gynecological condition-such as green tea and uterine fibroids. This review aims to help inform the diet choices of those with the aforementioned conditions and give those with uteruses autonomy over their lifestyle decisions.
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Affiliation(s)
- Rachel Michel
- Department of Population, Family, and Reproductive Health, Bloomberg School of Public Health, Baltimore, MD 21205 USA
| | - Dana Hazimeh
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD 21205 USA
| | - Eslam E. Saad
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD 21205 USA
| | - Sydney L. Olson
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD 21205 USA
| | - Kelsey Musselman
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD 21205 USA
| | - Eman Elgindy
- Department of Gynecology and Obstetrics, Zagazig University School of Medicine, Zagazig, 44519, Egypt
| | - Mostafa A. Borahay
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD 21205 USA
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Sunde J, Wasickanin M, Katz TA, Gillette L, Bidadi S, O’Neil D, Masand R, Burney RO, Pennington KA. The uterine secretome initiates growth of gynecologic tissues in ectopic locations. PLoS One 2024; 19:e0292978. [PMID: 38728307 PMCID: PMC11086859 DOI: 10.1371/journal.pone.0292978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 01/03/2024] [Indexed: 05/12/2024] Open
Abstract
Endosalpingiosis (ES) and endometriosis (EM) refer to the growth of tubal and endometrial epithelium respectively, outside of their site of origin. We hypothesize that uterine secretome factors drive ectopic growth. To test this, we developed a mouse model of ES and EM using tdTomato (tdT) transgenic fluorescent mice as donors. To block implantation factors, progesterone knockout (PKO) tdT mice were created. Fluorescent lesions were present after oviduct implantation with and without WT endometrium. Implantation was increased (p<0.05) when tdt oviductal tissue was implanted with endometrium compared to oviductal tissue alone. Implantation was reduced (p<0.0005) in animals implanted with minced tdT oviductal tissue with PKO tdT endometrium compared to WT endometrium. Finally, oviductal tissues was incubated with and without a known implantation factor, leukemia inhibitory factor (LIF) prior to and during implantation. LIF promoted lesion implantation. In conclusion, endometrial derived implantation factors, such as LIF, are necessary to initiate ectopic tissue growth. We have developed an animal model of ectopic growth of gynecologic tissues in a WT mouse which will potentially allow for development of new prevention and treatment modalities.
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Affiliation(s)
- Jan Sunde
- Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, WA, United States of America
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Baylor College of Medicine, Houston, TX, United States of America
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston TX, United States of America
| | - Morgan Wasickanin
- Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, WA, United States of America
| | - Tiffany A. Katz
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Baylor College of Medicine, Houston, TX, United States of America
| | - Laurel Gillette
- Department of Clinical Investigation, Madigan Army Medical Center, Tacoma, WA, United States of America
| | - Sanam Bidadi
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Baylor College of Medicine, Houston, TX, United States of America
| | - Derek O’Neil
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Baylor College of Medicine, Houston, TX, United States of America
| | - Ramya Masand
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston TX, United States of America
- Department of Pathology and Immunology, Baylor College of Medicine, Houston TX, United States of America
| | - Richard O. Burney
- Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, WA, United States of America
- Department of Clinical Investigation, Madigan Army Medical Center, Tacoma, WA, United States of America
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Kathleen A. Pennington
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Baylor College of Medicine, Houston, TX, United States of America
- Department of Obstetrics and Gynecology, Basic Sciences Perinatology Research Laboratories, Baylor College of Medicine, Houston, TX, United States of America
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Garnier L, Parant F, Bulteau C, Pescarmona R, Cerruto E, Moret S, Miguet-Bensouda C, Nohuz E, Chene G. Plasma and peritoneal fluid cytokine profiles in patient with Essure® implant: Towards a molecular signature? Eur J Obstet Gynecol Reprod Biol 2024; 296:349-353. [PMID: 38537321 DOI: 10.1016/j.ejogrb.2024.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 03/19/2024] [Accepted: 03/24/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVE(S) Many patients with Essure® implant may experience adverse events related to the device. Although local inflammation does not appear to be the pathophysiological mechanism underlying the symptoms, systemic inflammation could play a role. In the present study, as cytokines are involved in the inflammatory process, we proposed to investigate the profile of circulating and peritoneal cytokines. STUDY DESIGN In this retrospective study, we evaluated the levels of cytokines in peritoneal fluid (PF) as well as in plasma sample from three different groups: Essure® group, endometriosis group (known to be associated with immune dysregulation), and control group. RESULTS There were 60 symptomatic patients with Essure® device, 30 patients with endometriosis and a control group of 30 patients. The PF levels of Interleukin-10 (IL-10), Interleukin-6 (IL-6), and Monocyte chemoattractant protein-1 (MCP-1) were statistically higher in endometriosis group than in Essure® group and control group. The plasma level of MCP-1 was higher in Essure® group than in endometriosis group and control group. The plasma level of TNF-α was higher in Essure® group than in control group. CONCLUSIONS The chemokine MCP-1 as well as the pro-inflammatory TNF-α, are known to be increased in patients with fibromyalgia and chronic fatigue syndrome. Since patients with Essure® may exhibit symptoms similar to fibromyalgia, MCP-1 and TNF-α may be relevant markers in symptomatic patients with Essure®. Because of the lack of longitudinal data (no evaluation of postoperative cytokine profile and no assessment of the level of clinical improvement), other studies are needed to confirm these preliminary results.
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Affiliation(s)
- Lorna Garnier
- Immunology Laboratory, Hôpital Lyon-Sud, Hospices Civils de Lyon, Chemin du Grand-Revoyet, University hospital of Lyon, 69495 Pierre-Bénite, France
| | - François Parant
- Trace Element Analysis Laboratory, Biochemistry Department, CBAPS, Centre hospitalier Lyon-Sud, Chemin du Grand-Revoyet, University hospital of Lyon, 69495 Pierre-Benite, France
| | - Claire Bulteau
- Immunology Laboratory, Hôpital Lyon-Sud, Hospices Civils de Lyon, Chemin du Grand-Revoyet, University hospital of Lyon, 69495 Pierre-Bénite, France
| | - Remi Pescarmona
- Immunology Laboratory, Hôpital Lyon-Sud, Hospices Civils de Lyon, Chemin du Grand-Revoyet, University hospital of Lyon, 69495 Pierre-Bénite, France
| | - Emanuele Cerruto
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, 59 boulevard Pinel, University hospital of Lyon, 69500 Bron, France
| | - Stephanie Moret
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, 59 boulevard Pinel, University hospital of Lyon, 69500 Bron, France
| | - Chloe Miguet-Bensouda
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, 59 boulevard Pinel, University hospital of Lyon, 69500 Bron, France
| | - Erdogan Nohuz
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, 59 boulevard Pinel, University hospital of Lyon, 69500 Bron, France
| | - Gautier Chene
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, 59 boulevard Pinel, University hospital of Lyon, 69500 Bron, France; University Claude Bernard of Lyon 1, EMR 3738 CICLY, 69000 Lyon, France.
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Brulport A, Bourdon M, Vaiman D, Drouet C, Pocate-Cheriet K, Bouzid K, Marcellin L, Santulli P, Abo C, Jeljeli M, Chouzenoux S, Chapron C, Batteux F, Berthelot C, Doridot L. An integrated multi-tissue approach for endometriosis candidate biomarkers: a systematic review. Reprod Biol Endocrinol 2024; 22:21. [PMID: 38341605 PMCID: PMC10858544 DOI: 10.1186/s12958-023-01181-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 12/28/2023] [Indexed: 02/12/2024] Open
Abstract
Biomarker identification could help in deciphering endometriosis pathophysiology in addition to their use in the development of non invasive diagnostic and prognostic approaches, that are essential to greatly improve patient care. Despite extensive efforts, no single potential biomarker or combination has been clinically validated for endometriosis.Many studies have investigated endometriosis-associated biological markers in specific tissues, but an integrative approach across tissues is lacking. The aim of this review is to propose a comprehensive overview of identified biomarkers based on tissue or biological compartment, while taking into account endometriosis phenotypes (superficial, ovarian or deep, or rASRM stages), menstrual cycle phases, treatments and symptoms.We searched PubMed and Embase databases for articles matching the following criteria: 'endometriosis' present in the title and the associated term 'biomarkers' found as Medical Subject Headings (MeSH) terms or in all fields. We restricted to publications in English and on human populations. Relevant articles published between 01 January 2005 (when endometriosis phenotypes start to be described in papers) and 01 September 2022 were critically analysed and discussed.Four hundred forty seven articles on endometriosis biomarkers that included a control group without endometriosis and provided specific information on endometriosis phenotypes are included in this review. Presence of information or adjustment controlling for menstrual cycle phase, symptoms and treatments is highlighted, and the results are further summarized by biological compartment. The 9 biological compartments studied for endometriosis biomarker research are in order of frequency: peripheral blood, eutopic endometrium, peritoneal fluid, ovaries, urine, menstrual blood, saliva, feces and cervical mucus. Adjustments of results on disease phenotypes, cycle phases, treatments and symptoms are present in 70%, 29%, 3% and 6% of selected articles, respectively. A total of 1107 biomarkers were identified in these biological compartments. Of these, 74 were found in several biological compartments by at least two independent research teams and only 4 (TNF-a, MMP-9, TIMP-1 and miR-451) are detected in at least 3 tissues with cohorts of 30 women or more.Integrative analysis is a crucial step to highlight potential pitfalls behind the lack of success in the search for clinically relevant endometriosis biomarkers, and to illuminate the physiopathology of this disease.
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Affiliation(s)
- Axelle Brulport
- Institut Pasteur, Université Paris Cité, CNRS UMR 3525, INSERM UA12, Comparative Functional Genomics Group, Paris, 75015, France.
| | - Mathilde Bourdon
- Université Paris Cité, Institut Cochin, INSERM, CNRS, F-75014, Paris, France
- Département de Gynécologie, Obstétrique et Médecine de la Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin, F-75014, Paris, France
| | - Daniel Vaiman
- Université Paris Cité, Institut Cochin, INSERM, CNRS, F-75014, Paris, France
| | - Christian Drouet
- Université Paris Cité, Institut Cochin, INSERM, CNRS, F-75014, Paris, France
- Université de Paris, Faculté de Santé, Faculté de Médecine Paris Centre, Paris, France, Service de Biologie de la Reproduction - CECOS, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin, Paris, 75014, France
| | - Khaled Pocate-Cheriet
- Université Paris Cité, Institut Cochin, INSERM, CNRS, F-75014, Paris, France
- Université de Paris, Faculté de Santé, Faculté de Médecine Paris Centre, Paris, France, Service de Biologie de la Reproduction - CECOS, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin, Paris, 75014, France
| | - Kheira Bouzid
- Université Paris Cité, Institut Cochin, INSERM, CNRS, F-75014, Paris, France
| | - Louis Marcellin
- Université Paris Cité, Institut Cochin, INSERM, CNRS, F-75014, Paris, France
- Département de Gynécologie, Obstétrique et Médecine de la Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin, F-75014, Paris, France
| | - Pietro Santulli
- Université Paris Cité, Institut Cochin, INSERM, CNRS, F-75014, Paris, France
- Département de Gynécologie, Obstétrique et Médecine de la Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin, F-75014, Paris, France
| | - Carole Abo
- Université Paris Cité, Institut Cochin, INSERM, CNRS, F-75014, Paris, France
- Département de Gynécologie, Obstétrique et Médecine de la Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin, F-75014, Paris, France
| | - Maxime Jeljeli
- Université Paris Cité, Institut Cochin, INSERM, CNRS, F-75014, Paris, France
- Service d'Immunologie Biologique, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin, Paris, F-75014, France
| | - Sandrine Chouzenoux
- Université Paris Cité, Institut Cochin, INSERM, CNRS, F-75014, Paris, France
| | - Charles Chapron
- Université Paris Cité, Institut Cochin, INSERM, CNRS, F-75014, Paris, France
- Département de Gynécologie, Obstétrique et Médecine de la Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin, F-75014, Paris, France
| | - Frédéric Batteux
- Université Paris Cité, Institut Cochin, INSERM, CNRS, F-75014, Paris, France
- Service d'Immunologie Biologique, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin, Paris, F-75014, France
| | - Camille Berthelot
- Institut Pasteur, Université Paris Cité, CNRS UMR 3525, INSERM UA12, Comparative Functional Genomics Group, Paris, 75015, France
| | - Ludivine Doridot
- Université Paris Cité, Institut Cochin, INSERM, CNRS, F-75014, Paris, France
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Giudice LC, Oskotsky TT, Falako S, Opoku‐Anane J, Sirota M. Endometriosis in the era of precision medicine and impact on sexual and reproductive health across the lifespan and in diverse populations. FASEB J 2023; 37:e23130. [PMID: 37641572 PMCID: PMC10503213 DOI: 10.1096/fj.202300907] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/26/2023] [Indexed: 08/31/2023]
Abstract
Endometriosis is a common estrogen-dependent disorder wherein uterine lining tissue (endometrium) is found mainly in the pelvis where it causes inflammation, chronic pelvic pain, pain with intercourse and menses, and infertility. Recent evidence also supports a systemic inflammatory component that underlies associated co-morbidities, e.g., migraines and cardiovascular and autoimmune diseases. Genetics and environment contribute significantly to disease risk, and with the explosion of omics technologies, underlying mechanisms of symptoms are increasingly being elucidated, although novel and effective therapeutics for pain and infertility have lagged behind these advances. Moreover, there are stark disparities in diagnosis, access to care, and treatment among persons of color and transgender/nonbinary identity, socioeconomically disadvantaged populations, and adolescents, and a disturbing low awareness among health care providers, policymakers, and the lay public about endometriosis, which, if left undiagnosed and under-treated can lead to significant fibrosis, infertility, depression, and markedly diminished quality of life. This review summarizes endometriosis epidemiology, compelling evidence for its pathogenesis, mechanisms underlying its pathophysiology in the age of precision medicine, recent biomarker discovery, novel therapeutic approaches, and issues around reproductive justice for marginalized populations with this disorder spanning the past 100 years. As we enter the next revolution in health care and biomedical research, with rich molecular and clinical datasets, single-cell omics, and population-level data, endometriosis is well positioned to benefit from data-driven research leveraging computational and artificial intelligence approaches integrating data and predicting disease risk, diagnosis, response to medical and surgical therapies, and prognosis for recurrence.
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Affiliation(s)
- Linda C. Giudice
- UCSF Stanford Endometriosis Center for Innovation, Training, and Community Outreach (ENACT)University of California, San FranciscoSan FranciscoCaliforniaUSA
- Center for Reproductive SciencesUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Tomiko T. Oskotsky
- UCSF Stanford Endometriosis Center for Innovation, Training, and Community Outreach (ENACT)University of California, San FranciscoSan FranciscoCaliforniaUSA
- Bakar Computational Health Sciences InstituteUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Simileoluwa Falako
- UCSF Stanford Endometriosis Center for Innovation, Training, and Community Outreach (ENACT)University of California, San FranciscoSan FranciscoCaliforniaUSA
- Columbia University Vagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
| | - Jessica Opoku‐Anane
- UCSF Stanford Endometriosis Center for Innovation, Training, and Community Outreach (ENACT)University of California, San FranciscoSan FranciscoCaliforniaUSA
- Division of Gynecologic Specialty SurgeryColumbia UniversityNew YorkNew YorkUSA
| | - Marina Sirota
- UCSF Stanford Endometriosis Center for Innovation, Training, and Community Outreach (ENACT)University of California, San FranciscoSan FranciscoCaliforniaUSA
- Bakar Computational Health Sciences InstituteUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
- Department of PediatricsUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
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Harden S, Tan TY, Ku CW, Zhou J, Chen Q, Chan JKY, Brosens J, Lee YH. Peritoneal autoantibody profiling identifies p53 as an autoantibody target in endometriosis. Fertil Steril 2023; 120:176-187. [PMID: 36828054 DOI: 10.1016/j.fertnstert.2023.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVE To map the peritoneal autoantibody (AAb) landscape in women with endometriosis. DESIGN Case-control laboratory study. SETTING Academic medical and research units. PATIENT(S) Women who presented with or without endometriosis. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Using native-conformation and citrullinated modified protein arrays, proteome-wide analysis of AAbs against 1,623 proteins were profiled in peritoneal fluids (PFs) of 25 women with endometriosis and 25 women without endometriosis. RESULT(S) In women with endometriosis, the median number of AAbs detected was 4, including AAbs that targeted autoantigens involved in implantation, B-cell activation/development, and aberrant migration and mitogenicity. Forty-six percent of women with endometriosis have ≥5 peritoneal AAbs. Conversely, in women without endometriosis, the median number of detected AAbs was 1. Autoantibodies recognizing tumor suppressor protein p53 were the most commonly detected AAbs, being present in 35% of women with endometriosis, and p53 AAb was associated with a monocyte/macrophage-like PF cytokine signature. Further investigation of the global reactivity of AAbs against citrullinated PF antigens by peptidylarginine deiminase enzymes 1, 2, and 6 revealed anticitrullinated p53 as the only AAb target elevated and citrullinated by all 3 peptidylarginine deiminase isotypes. Furthermore, unsupervised hierarchical clustering and integrative pathway analysis revealed that 60% of women with endometriosis-associated infertility were positive for AAbs, which are involved in platelet-derived growth factor, transforming growth factor-β, RAC1/PAK1/p38/MMP2 signaling, LAT2/NTAL/LAB-mediated calcium mobilization, and integrin-mediated cell adhesion. CONCLUSION(S) Together, our data identify peritoneal autoimmunity in a significant subset of women with endometriosis, with implications on infertility and disease pathophysiology. In these patients, p53 was identified as the most frequent PF AAb target, which was present in both the native and citrullinated forms.
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Affiliation(s)
- Sarah Harden
- Critical Analytics for Manufacturing Precision Medicine, Singapore-MIT Alliance for Research and Technology, Singapore, Singapore; Division of Biomedical Sciences, Clinical Science Research Laboratories, Warwick Medical School, University of Warwick, Coventry, United Kingdom; Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore, Singapore
| | - Tse Yeun Tan
- Department of Reproductive Medicine, KKH, Singapore, Singapore; OBGYN-Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Chee Wai Ku
- Department of Reproductive Medicine, KKH, Singapore, Singapore; OBGYN-Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Jieliang Zhou
- KK Research Centre, KK Women's and Children's Hospital, Singapore, Singapore
| | - Qingfeng Chen
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore, Singapore
| | - Jerry Kok Yen Chan
- Department of Reproductive Medicine, KKH, Singapore, Singapore; OBGYN-Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Jan Brosens
- Division of Biomedical Sciences, Clinical Science Research Laboratories, Warwick Medical School, University of Warwick, Coventry, United Kingdom; Tommy's National Centre for Miscarriage Research, University Hospitals Coventry & Warwickshire, Coventry, United Kingdom; Centre for Early Life, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Yie Hou Lee
- Critical Analytics for Manufacturing Precision Medicine, Singapore-MIT Alliance for Research and Technology, Singapore, Singapore; OBGYN-Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore; KK Research Centre, KK Women's and Children's Hospital, Singapore, Singapore.
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10
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Wang Y, Chen Y, Xiao Y, Ruan J, Tian Q, Cheng Q, Chang K, Yi X. Distinct subtypes of endometriosis identified based on stromal-immune microenvironment and gene expression: implications for hormone therapy. Front Immunol 2023; 14:1133672. [PMID: 37426659 PMCID: PMC10324653 DOI: 10.3389/fimmu.2023.1133672] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/31/2023] [Indexed: 07/11/2023] Open
Abstract
Background Endometriosis (EMs) is a chronic inflammatory condition that is highly heterogeneous. Current clinical staging fails to accurately predict drug responses and prognosis. In this study, we aimed to reveal the heterogeneity of ectopic lesions and investigate the possible underlying mechanisms using transcriptomic data and clinical information. Methods The EMs microarray dataset GSE141549 was obtained from the Gene Expression Omnibus database. Unsupervised hierarchical clustering was performed to identify EMs subtypes, which was followed by the functional enrichment analysis and estimation of immune infiltrates. Subtype-associated gene signatures were identified and further validated in other independent datasets, including GSE25628, E-MTAB-694, and GSE23339. Additionally, tissue microarrays (TMAs) were generated from premenopausal patients with EMs to investigate the potential clinical implications of the two identified subtypes. Results The unsupervised clustering analysis revealed that ectopic EMs lesions can be classified into two distinct subtypes: stroma-enriched (S1) and immune-enriched (S2). The functional analysis revealed that S1 correlated with fibroblast activation and extracellular matrix remodeling in the ectopic milieu, whereas S2 was characterized by the upregulation of immune pathways and a higher positive correlation with the immunotherapy response. Moreover, we identified a subtype signature composed of FHL1 and SORBS1, and constructed a subtype diagnostic model. Based on the cohort data from the TMAs, we found that S2 was strongly associated with the failure of/intolerance to hormone therapy. Conclusions This study identified two distinct subtypes that are varyingly associated with hormone resistance, stroma-immunity, and molecular features, thereby highlighting the importance of this stromal-immune heterogeneity in identifying EMs subtypes and providing novel insights into future personalized hormone-free therapy in EMs.
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Affiliation(s)
- Yuning Wang
- Department of Gynecology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China
| | - Yun Chen
- Department of Gynecology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China
- Key Laboratory of Female Reproductive Endocrine Related Diseases, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China
| | - Yinping Xiao
- Department of Gynecology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China
| | - Jingyao Ruan
- Department of Gynecology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China
| | - Qi Tian
- Department of Gynecology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China
| | - Qi Cheng
- Department of Gynecology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China
| | - Kaikai Chang
- Department of Gynecology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China
- Key Laboratory of Female Reproductive Endocrine Related Diseases, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China
| | - Xiaofang Yi
- Department of Gynecology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China
- Key Laboratory of Female Reproductive Endocrine Related Diseases, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China
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11
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Viardot-Foucault V, Zhou J, Bi D, Takinami Y, Chan JKY, Lee YH. Dehydroepiandrosterone supplementation and the impact of follicular fluid metabolome and cytokinome profiles in poor ovarian responders. J Ovarian Res 2023; 16:107. [PMID: 37268990 PMCID: PMC10239139 DOI: 10.1186/s13048-023-01166-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/25/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Poor ovarian responders (POR) are women undergoing in-vitro fertilization who respond poorly to ovarian stimulation, resulting in the retrieval of lower number of oocytes, and subsequently lower pregnancy rates. The follicular fluid (FF) provides a crucial microenvironment for the proper development of follicles and oocytes through tightly controlled metabolism and cell signaling. Androgens such as dehydroepiandrosterone (DHEA) have been proposed to alter the POR follicular microenvironment, but the impact DHEA imposes on the FF metabolome and cytokine profiles is unknown. Therefore, the objective of this study is to profile and identify metabolomic changes in the FF with DHEA supplementation in POR patients. METHODS FF samples collected from 52 POR patients who underwent IVF with DHEA supplementation (DHEA +) and without (DHEA-; controls) were analyzed using untargeted liquid chromatography-tandem mass spectrometry (LC-MS/MS) metabolomics and a large-scale multiplex suspension immunoassay covering 65 cytokines, chemokines and growth factors. Multivariate statistical modelling by partial least squares-discriminant regression (PLSR) analysis was performed for revealing metabolome-scale differences. Further, differential metabolite analysis between the two groups was performed by PLSR β-coefficient regression analysis and Student's t-test. RESULTS Untargeted metabolomics identified 118 FF metabolites of diverse chemistries and concentrations which spanned three orders of magnitude. They include metabolic products highly associated with ovarian function - amino acids for regulating pH and osmolarity, lipids such fatty acids and cholesterols for oocyte maturation, and glucocorticoids for ovarian steroidogenesis. Four metabolites, namely, glycerophosphocholine, linoleic acid, progesterone, and valine were significantly lower in DHEA + relative to DHEA- (p < 0.05-0.005). The area under the curves of progesterone glycerophosphocholine, linoleic acid and valine are 0.711, 0.730, 0.785 and 0.818 (p < 0.05-0.01). In DHEA + patients, progesterone positively correlated with IGF-1 (Pearson r: 0.6757, p < 0.01); glycerophosphocholine negatively correlated with AMH (Pearson r: -0.5815; p < 0.05); linoleic acid correlated with estradiol and IGF-1 (Pearson r: 0.7016 and 0.8203, respectively; p < 0.01 for both). In DHEA- patients, valine negatively correlated with serum-free testosterone (Pearson r: -0.8774; p < 0.0001). Using the large-scale immunoassay of 45 cytokines, we observed significantly lower MCP1, IFNγ, LIF and VEGF-D levels in DHEA + relative to DHEA. CONCLUSIONS In POR patients, DHEA supplementation altered the FF metabolome and cytokine profile. The identified four FF metabolites that significantly changed with DHEA may provide information for titrating and monitoring individual DHEA supplementation.
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Affiliation(s)
- Veronique Viardot-Foucault
- Department of Reproductive Medicine, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, 229899 Singapore
| | - Jieliang Zhou
- Translational ‘Omics and Biomarkers Group, KK Research Centre, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, 229899 Singapore
| | - Dexi Bi
- Department of Pathology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 200072 China
| | - Yoshihiko Takinami
- Bruker Japan, 3-9 Yokohama City, Kanagawa, 220-0022 Japan
- Present Address: Kanomax Analytical Incorportated, Shimizu Suita City, Osaka Japan
| | - Jerry. K. Y. Chan
- Department of Reproductive Medicine, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, 229899 Singapore
- Obstetrics and Gynaecology Academic Clinical Program, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
| | - Yie Hou Lee
- Translational ‘Omics and Biomarkers Group, KK Research Centre, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, 229899 Singapore
- Obstetrics and Gynaecology Academic Clinical Program, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Singapore-MIT Alliance for Research and Technoology, 1 CREATE Way, Singapore, 138602 Singapore
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12
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Does the Use of the "Proseek ® Multiplex Inflammation I Panel" Demonstrate a Difference in Local and Systemic Immune Responses in Endometriosis Patients with or without Deep-Infiltrating Lesions? Int J Mol Sci 2023; 24:ijms24055022. [PMID: 36902452 PMCID: PMC10003683 DOI: 10.3390/ijms24055022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 02/16/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023] Open
Abstract
Endometriotic lesions are able to infiltrate surrounding tissue. This is made possible partly by an altered local and systemic immune response that helps achieve neoangiogenesis, cell proliferation and immune escape. Deep-infiltrating endometriosis (DIE) differs from other subtypes through the invasion of its lesions over 5 mm into affected tissue. Despite the invasive nature of these lesions and the wider range of symptoms they can trigger, DIE is described as a stable disease. This elicits the need for a better understanding of the underlying pathogenesis. We used the "Proseek® Multiplex Inflammation I Panel" in order to simultaneously detect 92 inflammatory proteins in plasma and peritoneal fluid (PF) of controls and patients with endometriosis, as well as in particular patients with DIE, in order to gain a better insight into the systemically and locally involved immune response. Extracellular newly identified receptor for advanced gycation end-products binding protein (EN-RAGE), C-C motif Chemokine ligand 23 (CCL23), Eukaryotic translation initiation factor 4-binding protein 1 (4E-BP1) and human glial cell-line derived neurotrophic factor (hGDNF) were significantly increased in plasma of endometriosis patients compared to controls, whereas Hepatocyte Growth factor (HGF) and TNF-related apoptosis inducing ligand (TRAIL) were decreased. In PF of endometriosis patients, we found Interleukin 18 (IL-18) to be decreased, yet Interleukin 8 (IL-8) and Interleukin 6 (IL-6) to be increased. TNF-related activation-induced cytokine (TRANCE) and C-C motif Chemokine ligand 11 (CCL11) were significantly decreased in plasma, whereas C-C motif Chemokine ligand 23 (CCL23), Stem Cell Factor (SCF) and C-X-C motif chemokine 5 (CXCL5) were significantly increased in PF of patients with DIE compared to endometriosis patients without DIE. Although DIE lesions are characterized by increased angiogenetic and pro-inflammatory properties, our current study seems to support the theory that the systemic immune system does not play a major role in the pathogenesis of these lesions.
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13
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Zare M, Hesampour F, Poordast T, Valibeigi M, Enayatmehri M, Ahmadi S, Nasri F, Gharesi-Fard B. Association between gene polymorphisms of IL-12, IL-12 receptor and IL-27 and organ involvement in Iranian endometriosis patients. Int J Immunogenet 2023; 50:24-33. [PMID: 36328955 DOI: 10.1111/iji.12606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/07/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
Endometriosis is an inflammatory disease characterized by the presence of ectopic endometrial tissue, immune cell dysfunction and abnormal cytokine secretion. In addition to immunological factors, genetic variations that influence endometriosis severity and cytokine expression levels play important roles in the pathogenesis of this disease. Interleukin-12 (IL-12), specifically its p40 subunit encoded by IL-12B gene and the interleukin-12 receptor β1 (IL-12Rβ2) chain of its receptor, as well as interleukin-27 (IL-27) are important in the establishment of endometriosis. So, in this study, we measured IL-12 and IL-27 serum levels and investigated the possible links between IL-12B rs3212227, IL-12Rβ2 rs3790565 and IL-27 rs153109 polymorphisms and the risk of developing endometriosis in a group of Iranian women. In this case-control study, 162 endometriosis patients and 151 healthy women were included and tested for the aforementioned polymorphisms using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. The enzyme-linked immunosorbent assay (ELISA) method was also used to measure IL-12 and IL-27 serum levels. Although there was no statistically significant association between the genotypes and alleles of the studied polymorphisms and the development of endometriosis in general, the AA genotype of IL-12B rs3212227 showed a significant association with uterine endometriosis when compared to AC+CC genotypes (p = .04, CI = 0.270-0.988, OR = 0.517). Indeed, the AA genotype of the IL-12B rs3212227 single nucleotide polymorphism (SNP) may be linked with a lower risk of developing uterine endometriosis. There was no significant difference in IL-27 levels between the two studied groups (p = .49), and IL-12 levels were undetectable in both groups. In conclusion, the AA genotype of IL-12B rs3212227 might be associated with a decreased risk of uterine involvement in endometriosis patients.
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Affiliation(s)
- Maryam Zare
- Department of Immunology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Faculty of Medicine, Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Canada
| | - Fatemeh Hesampour
- Department of Immunology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Rady Faculty of Health Science, Department of Immunology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, R3E0T5, Canada
| | - Tahereh Poordast
- Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Valibeigi
- Department of Immunology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maliheh Enayatmehri
- Department of Immunology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sahar Ahmadi
- Department of Immunology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Nasri
- Department of Laboratory Sciences, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.,Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Behrouz Gharesi-Fard
- Department of Immunology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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14
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Ku CW, Ong LS, Goh JP, Allen J, Low LW, Zhou J, Tan TC, Lee YH. Defects in protective cytokine profiles in spontaneous miscarriage in the first trimester. F&S SCIENCE 2023; 4:36-46. [PMID: 36096448 DOI: 10.1016/j.xfss.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 09/04/2022] [Accepted: 09/06/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To study differences in cytokine expression profiles between women with ongoing pregnancy and those experiencing spontaneous miscarriage, among women who presented with threatened miscarriage before week 16 of gestation. DESIGN Prospective cohort study. SETTING Academic hospital. PATIENT(S) In this prospective cohort study, 155 pregnant women, comprising normal pregnant women recruited from antenatal clinics (n = 97) and women with threatened miscarriage recruited from an emergency walk-in clinic (n = 58). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Sixty-five serum cytokines quantified using multiplex immunoassay correlated with miscarriage outcomes. RESULT(S) Among women presenting with threatened miscarriage, those who eventually miscarried had significantly lower levels of interleukin (IL)-2, IL-12p70, IL-17A, B-cell-activating factor, B lymphocyte chemoattractant, basic nerve growth factor, interferon-γ, tumor necrosis factor-related apoptosis-inducing ligand, thymic stromal lymphopoietin, and tumor necrosis factor-α and higher levels of vascular endothelial growth factor A, IL-21, and stromal cell-derived factor 1α than those with ongoing pregnancy. Comparisons between normal pregnancies and women with threatened miscarriage who eventually miscarried revealed significant differences across 7 cytokines: B-cell-activating factor; B lymphocyte chemoattractant; basic nerve growth factor; IL-17A; fractalkine/CX3CL1; vascular endothelial growth factor A; and CCL22. Vascular endothelial growth factor A exhibited a negative correlation with the progesterone level (r = -0.270). The cluster of significant cytokines alludes to T cell proliferation, B-cell proliferation, natural killer cell-mediated cytotoxicity, and apoptosis as important pathways that determine pregnancy outcomes. Bioinformatic analysis further revealed alteration of the suppressor of cytokine signaling proteins family of Janus kinase-signal transducer and activator of transcription signaling axis by cytokines as a plausible key molecular mechanism in spontaneous miscarriage. CONCLUSION(S) This study demonstrates that the regulated balance between the proinflammatory and anti-inflammatory pathways is crucial to maintaining pregnancy. A better understanding of the cytokines associated with immunomodulatory effects may lead to novel targets for the prediction and treatment of spontaneous miscarriage.
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Affiliation(s)
- Chee Wai Ku
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore; Duke-NUS Medical School, Singapore
| | | | - Jody Paige Goh
- Division of Obstetrics and Gynecology, KK Women's and Children's Hospital, Singapore
| | | | - Louise Wenyi Low
- Division of Obstetrics and Gynecology, KK Women's and Children's Hospital, Singapore; Obstetrics and Gynecology-Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Jieliang Zhou
- Division of Obstetrics and Gynecology, KK Women's and Children's Hospital, Singapore; Obstetrics and Gynecology-Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Thiam Chye Tan
- Division of Obstetrics and Gynecology, KK Women's and Children's Hospital, Singapore; Obstetrics and Gynecology-Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Yie Hou Lee
- Obstetrics and Gynecology-Academic Clinical Program, Duke-NUS Medical School, Singapore; Translational 'Omics and Biomarkers Group, KK Research Centre, KK Women's and Children's Hospital, Singapore.
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15
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Higher Oxidative Stress in Endometriotic Lesions Upregulates Senescence-Associated p16 ink4a and β-Galactosidase in Stromal Cells. Int J Mol Sci 2023; 24:ijms24020914. [PMID: 36674426 PMCID: PMC9860681 DOI: 10.3390/ijms24020914] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/12/2022] [Accepted: 12/16/2022] [Indexed: 01/06/2023] Open
Abstract
Endometriosis affects a significant proportion of women worldwide; however, no definitive cure for this disease has been discovered to date. Oxidative stress promotes endometriotic lesion maintenance in the peritoneal cavity in women. Furthermore, there is evidence of the mitogen-activated protein kinase (MAPK) signaling pathway and senescence involvement in the physiopathogenesis of endometriosis. Reactive oxygen species (ROS) cause oxidative damage and are expected to trigger senescence in the endometrium while also causing alterations in MAPK signaling. However, the role of ROS in the senescence-associated phenotype in endometriosis remains unknown. In this context, this study attempted to delineate the pathways linking ROS to senescence in endometrial and endometriotic lesions of healthy individuals and those with endometriosis. Our results indicate a higher presence of ROS in endometriotic lesions, and the upregulation of MAPK. Furthermore, we show that endometriotic lesions in stromal cells stimulated with hydrogen peroxide develop more senescence traits than eutopic and non-endometriosis endometrium. Overall, endometriotic cells respond differently to extracellular distress. Our contribution to further research in this field contributed to the roadmap of endometriosis' search for alternative treatments.
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16
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Hu S, Guo W, Shen Y. Potential link between the nerve injury-induced protein (Ninjurin) and the pathogenesis of endometriosis. Int Immunopharmacol 2023; 114:109452. [PMID: 36446236 DOI: 10.1016/j.intimp.2022.109452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/29/2022] [Accepted: 11/10/2022] [Indexed: 11/27/2022]
Abstract
Endometriosis remains a widespread but severe gynecological disease in women of reproductive age, with an unknown etiology and few treatment choices. The menstrual reflux theory is largely accepted as the underlying etiology but does not explain the morbidity or unpleasant pain sensations of endometriosis. The neurological and immune systems are both involved in pain mechanisms of endometriosis, and interlinked through a complex combination of cytokines and neurotransmitters. Numerous pieces of evidence suggest that the nerve injury-inducible protein, Ninjurin, is actively expressed in endometriosis lesions, which contributes to the etiology and development of endometriosis. It may be explored in the future as a novel therapeutic target. The aim of the present review was to elucidate the multifaceted role of Ninjurin. Furthermore, we summarize the association of Ninjurin with the pain mechanism of endometriosis and outline the future research directions. A novel therapeutic pathway can be discovered based on the potential pathogenic variables.
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Affiliation(s)
- Sijian Hu
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Weina Guo
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yi Shen
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
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17
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Decreased Innate Migration of Pro-Inflammatory M1 Macrophages through the Mesothelial Membrane Is Affected by Ceramide Kinase and Ceramide 1-P. Int J Mol Sci 2022; 23:ijms232415977. [PMID: 36555618 PMCID: PMC9785226 DOI: 10.3390/ijms232415977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/04/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
The retrograde flow of endometrial tissues deposited into the peritoneal cavity occurs in women during menstruation. Classically (M1) or alternatively (M2) activated macrophages partake in the removal of regurgitated menstrual tissue. The failure of macrophage egress from the peritoneal cavity through the mesothelium leads to chronic inflammation in endometriosis. To study the migration differences of macrophage phenotypes across mesothelial cells, an in vitro model of macrophage egress across a peritoneal mesothelial cell monolayer membrane was developed. M1 macrophages were more sessile, emigrating 2.9-fold less than M2 macrophages. The M1 macrophages displayed a pro-inflammatory cytokine signature, including IL-1α, IL-1β, TNF-α, TNF-β, and IL-12p70. Mass spectrometry sphingolipidomics revealed decreased levels of ceramide-1-phosphate (C1P), an inducer of migration in M1 macrophages, which correlated with its poor migration behavior. C1P is generated by ceramide kinase (CERK) from ceramide, and blocking C1P synthesis via the action of NVP231, a specific CERK chemical inhibitor, prohibited the emigration of M1 and M2 macrophages up to 6.7-fold. Incubation with exogenously added C1P rescued this effect. These results suggest that M1 macrophages are less mobile and have higher retention in the peritoneum due to lower C1P levels, which contributes to an altered peritoneal environment in endometriosis by generating a predominant pro-inflammatory cytokine environment.
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18
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Teworte S, Luciani P. Endometriosis, the Silent Disease: Molecular Targets, Active Principles, and Drug Delivery Systems. Helv Chim Acta 2022. [DOI: 10.1002/hlca.202200132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Sarah Teworte
- Department of Chemistry Biochemistry and Pharmaceutical Sciences University of Bern Freiestrasse 3 CH-3012 Bern Switzerland
| | - Paola Luciani
- Department of Chemistry Biochemistry and Pharmaceutical Sciences University of Bern Freiestrasse 3 CH-3012 Bern Switzerland
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19
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Niclosamide targets the dynamic progression of macrophages for the resolution of endometriosis in a mouse model. Commun Biol 2022; 5:1225. [DOI: 10.1038/s42003-022-04211-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/01/2022] [Indexed: 11/13/2022] Open
Abstract
AbstractDue to the vital roles of macrophages in the pathogenesis of endometriosis, targeting macrophages could be a promising therapeutic direction. Here, we investigated the efficacy of niclosamide for the resolution of a perturbed microenvironment caused by dysregulated macrophages in a mouse model of endometriosis. Single-cell transcriptomic analysis revealed the heterogeneity of macrophages including three intermediate subtypes with sharing characteristics of traditional “small” or “large” peritoneal macrophages (SPMs and LPMs) in the peritoneal cavity. Endometriosis-like lesions (ELL) enhanced the differentiation of recruited macrophages, promoted the replenishment of resident LPMs, and increased the ablation of embryo-derived LPMs, which were stepwise suppressed by niclosamide. In addition, niclosamide restored intercellular communications between macrophages and B cells. Therefore, niclosamide rescued the perturbed microenvironment in endometriosis through its fine regulations on the dynamic progression of macrophages. Validation of similar macrophage pathogenesis in patients will further promote the clinical usage of niclosamide for endometriosis treatment.
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20
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Li Piani L, Chiaffarino F, Cipriani S, Viganò P, Somigliana E, Parazzini F. A systematic review and meta-analysis on alcohol consumption and risk of endometriosis: an update from 2012. Sci Rep 2022; 12:19122. [PMID: 36352037 PMCID: PMC9645754 DOI: 10.1038/s41598-022-21173-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 09/23/2022] [Indexed: 11/11/2022] Open
Abstract
Endometriosis is a complex and chronic disease, whose multifactorial nature has encouraged a deep investigation on the role of lifestyle factors. A strong association between alcohol intake and endometriosis risk has already been shown. We aimed to confirm this association, considering the updated literature. 23 eligible studies were identified through comprehensive literature search of PubMed and EMBASE (May 2012-October 2021). A borderline statistical significance was found comparing any alcohol consumption with no consumption (unadjusted OR 1.14; 95% CI: 0.99-1.31, p = 0.06), in contrast with a previous meta-analysis. However, we confirmed the significant association between moderate alcohol intake and endometriosis (unadjusted OR 1.22, 95% CI: 1.03-1.45, p = 0.02), also performing a sensitivity analysis (unadjusted OR 1.27, 95% CI: 1.04-1.54). Our partly divergent evidence reflects the tough challenge of isolating the impact of specific factors on the natural history of multifactorial diseases. Indeed, on one hand alcohol could be adopted by patients as a self-management therapy and on the other, it could favor the disease, promoting positive feedback with inflammatory mediators and oxidative stress. Our study encourages further investigation on the role of modifiable lifestyle factors and highlights the opportunity to adopt them to prevent or at least limit endometriosis progression.
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Affiliation(s)
- Letizia Li Piani
- grid.4708.b0000 0004 1757 2822Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy ,grid.414818.00000 0004 1757 8749Infertility Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via M. Fanti, 6, 20122 Milan, Italy
| | - Francesca Chiaffarino
- grid.414818.00000 0004 1757 8749Gynecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Sonia Cipriani
- grid.414818.00000 0004 1757 8749Gynecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Paola Viganò
- grid.414818.00000 0004 1757 8749Infertility Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via M. Fanti, 6, 20122 Milan, Italy
| | - Edgardo Somigliana
- grid.4708.b0000 0004 1757 2822Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy ,grid.414818.00000 0004 1757 8749Infertility Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via M. Fanti, 6, 20122 Milan, Italy
| | - Fabio Parazzini
- grid.4708.b0000 0004 1757 2822Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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21
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Li W, LibinWeng. Examination on Risk Factors of Infertility Caused by EMT and Their Correlation with VEGF, TNF- α, IL-6, IL-10, and IL-17. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:4421418. [PMID: 36159171 PMCID: PMC9489410 DOI: 10.1155/2022/4421418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 08/01/2022] [Accepted: 08/05/2022] [Indexed: 12/01/2022]
Abstract
In order to explore the risk factors of infertility caused by endometriosis (EMT) and their correlation with vascular endothelial growth factor (VEGF), TNF-α, IL-6, IL-10, and IL-17, endometriosis sufferers admitted to our hospital from January 2021 to May 2022 are selected to conduct the examination. According to the pregnancy of patients, patients were included in the simple EMT set and EMT combined infertility set, with 50 cases in each group. The degree of dysmenorrhea is evaluated by the VAS score, and Luminex liquid protein is used to analyze the standards of the tumor necrosis factor (TNF-A), interleukin (IL)-10, IL-6, IL-17, and VEGF. Logistic multifactor regression decomposition is applied to analyze the risk factors of infertility in EMT sufferers. Besides, the standards of VEGF, TNF-α, IL-6, IL-10, and IL-17 in sufferers with different periods/agony degrees are evaluated, and the correlation of different periods/agony degrees with VEGF, TNF-α, IL-6, IL-10, and IL-17 is analyzed. The results show that the different R-AFS periods are notoriously positively correlated with VEGF, TNF-α, IL-6, IL-10, and IL-17 (all P < 0.05), and the VAS score is notoriously positively correlated with the abovementioned factors.
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Affiliation(s)
- Wei Li
- Affiliated People's Hospital of Ningbo University, Ningbo 315040, China
| | - LibinWeng
- Ningbo Haishu District Third Hospital, Ningbo 315171, China
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22
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Unveil the pain of endometriosis: from the perspective of the nervous system. Expert Rev Mol Med 2022; 24:e36. [PMID: 36059111 DOI: 10.1017/erm.2022.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Endometriosis is a chronic inflammatory disease with pelvic pain and uncharacteristic accompanying symptoms. Endometriosis-associated pain often persists despite treatment of the disease, thus it brings a deleterious impact on their personal lives as well as imposing a substantial economic burden on them. At present, mechanisms underlie endometriosis-associated pain including inflammatory reaction, injury, aberrant blood vessels and the morphological and functional anomaly of the peripheral and central nervous systems. The nerve endings are influenced by the physical and chemical factors surrounding the lesion, via afferent nerve to the posterior root of the spinal nerve, then to the specific cerebral cortex involved in nociception. However, our understanding of the aetiology and mechanism of this complex pain process caused by endometriosis remains incomplete. Identifying the pathogenesis of endometriosis is crucial to disease management, offering proper treatment, and helping patients to seek novel targets for the maintenance and contributors of chronic pain. The main aim of this review is to focus on every possible mechanism of pain related to endometriosis in both peripheral and central nervous systems, and to present related mechanisms of action from the interaction between peripheral lesions and nerves to the changes in transmission of pain, resulting in hyperalgesia and the corresponding alterations in cerebral cortex and brain metabolism.
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23
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Guo C, Zhang C. Platelet-to-Lymphocyte Ratio and CA125 Level as a Combined Biomarker for Diagnosing Endometriosis and Predicting Pelvic Adhesion Severity. Front Oncol 2022; 12:896152. [PMID: 35800055 PMCID: PMC9255667 DOI: 10.3389/fonc.2022.896152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/19/2022] [Indexed: 11/16/2022] Open
Abstract
Adhesion is a significant biological characteristic of endometriosis, and accurate evaluation of the pelvic adhesion is necessary for surgical treatment. Serum CA125 is yet the most common used biomarker in the diagnosis and follow-up of patients with endometriosis despite of its high false-positive rate and low specificity. Herein, we aimed to examine the diagnostic value of the combination of the platelet-to-lymphocyte ratio (PLR) and CA125 for patients with different stages of endometriosis and their correlations with pelvic adhesion. We retrospectively analyzed the clinical data and blood count parameters of patients with both endometriosis and other benign ovarian tumors. The mean level of CA125, the PLR and the combined marker (the CA125 level multiplied by the PLR) in the EMs group were significantly higher than those in the Cyst group (P < 0.05). ROC curve analysis was used to compare the diagnostic values of serum PLR, CA125, and the combined marker in ovarian endometriosis. The cut-off value of the PLR was 176.835, with 28.3% sensitivity and 96.9% specificity. The cut-off value of CA125 was 31.67 U/mL, with 84.1% sensitivity and 87.4% specificity. The cut-off value of the combined marker was 3894.97, with 83.4% sensitivity and 95.8% specificity. It was found that the severity of adhesion in endometriosis was positively correlated with the PLR (r = 0.286, P < 0.01), CA125 (r = 0.276, P < 0.01), and combined marker (r = 0.369, P < 0.01). The combined marker showed the highest AUC value (0.751, 95% CI: 0.666–0.837), with a sensitivity of 56.0% and a specificity of 89.6%, and the cut-off value was 9056.94. Besides, the levels of CA125, PLR, and their combination were significantly elevated in patients with endometriosis. The combined marker was not only positively correlated with pelvic adhesion but also showed a greater diagnostic value and specificity than CA125 alone. These findings indicate that the combined marker may be a potential inflammatory biomarker playing an important role in the diagnosis and assessment of adhesion in endometriosis.
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Llarena NC, Hur CE, Yao M, Schwartz K, Falcone T, Desai N. The impact of endometriosis on embryo morphokinetics: embryos from endometriosis patients exhibit delayed cell cycle milestones and decreased blastulation rates. J Assist Reprod Genet 2022; 39:619-628. [PMID: 35099662 PMCID: PMC8995217 DOI: 10.1007/s10815-022-02406-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 01/18/2022] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To compare morphokinetic parameters in embryos obtained from women with and without endometriosis. METHODS We evaluated a total of 3471 embryos resulting from 434 oocyte retrievals performed at a single academic center. One thousand seventy-eight embryos were obtained from women affected by endometriosis and 2393 came from unaffected controls. All embryos were cultured in a time-lapse incubator chamber for up to 6 days. IVF cycle outcomes and morphokinetic parameters collected prospectively were retrospectively reviewed. RESULTS Morphokinetic data suggest that embryo development is impaired in embryos obtained from women with endometriosis (EE). EE were slower to achieve the 2-8 cell stages compared to control embryos (CE) (p < 0.001); additionally, time to compaction was delayed compared to CE (p = 0.015). The timing of late developmental events, including morulation and blastulation was also delayed in the endometriosis cohort (p < 0.001). In addition to demonstrating delayed cell cycle milestones, EE were less likely than controls to progress to morula, blastocyst, and expanded blastocyst stages (p < 0.001). Furthermore, a smaller proportion of embryos in the endometriosis group fell into optimal kinetic ranges for cc2 (p = 0.003), t5 (p = 0.019), tSB (p < 0.001), and tEB (p = 0.007). There were no significant differences in clinical pregnancy or live birth rates between groups. CONCLUSION Embryos from endometriosis patients demonstrate impairments in both early and late developmental events, and progress to the morula, blastocyst, and expanded blastocyst stages at lower rates than control embryos. Despite these differences, IVF outcomes are similar for patients with and without endometriosis.
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Affiliation(s)
- Natalia C Llarena
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Women's Health Institute, Cleveland Clinic, 26,900 Cedar Road, Beachwood, OH, 44,122, USA
| | - Christine E Hur
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Women's Health Institute, Cleveland Clinic, 26,900 Cedar Road, Beachwood, OH, 44,122, USA
| | - Meng Yao
- Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Ave. JJN3, Cleveland, OH, 44,195, USA
| | - Kaia Schwartz
- Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH, 44,195, USA
| | - Tommaso Falcone
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Women's Health Institute, Cleveland Clinic, 26,900 Cedar Road, Beachwood, OH, 44,122, USA
- Cleveland Clinic London, , 40 Grosvenor Place, London, SW1X 7AW, UK
| | - Nina Desai
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Women's Health Institute, Cleveland Clinic, 26,900 Cedar Road, Beachwood, OH, 44,122, USA.
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25
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Chen ZY, Zhang LF, Zhang YQ, Zhou Y, Li XY, Huang XF. Blood tests for prediction of deep endometriosis: A case-control study. World J Clin Cases 2021; 9:10805-10815. [PMID: 35047592 PMCID: PMC8678869 DOI: 10.12998/wjcc.v9.i35.10805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/16/2021] [Accepted: 09/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Deep endometriosis (DE) is the most aggressive subtype of endometriosis. The diagnosis may be challenging, and no biomarkers that can discriminate women with DE from those without DE have been developed.
AIM To evaluate the role of blood hemostatic parameters and inflammatory indices in the prediction of DE.
METHODS This case-control study was performed at the Women’s Hospital, Zhejiang University School of Medicine between January 2015 and December 2016. Women with DE and women with benign gynecologic disease (control group) eligible for gynecological surgery were enrolled. Routine plasma hemostatic parameters and inflammatory indices were obtained before surgery. Univariate and multivariate analysis were performed. Receiver operating characteristic (ROC) curves were generated, and areas under the curve (AUC) were calculated to assess the predictive values of the selected parameters.
RESULTS A total of 126 women were enrolled, including 31 with DE and 95 controls. Plasma fibrinogen (Fg, P < 0.01), international normalized ratio (P < 0.05), and C-reactive protein levels (P < 0.01) were significantly higher in women with DE compared with controls. Plasma hemoglobin (HB) levels (P < 0.05) and shortened thrombin time (P < 0.05) were significantly lower in women with DE than in controls. Plasma Fg levels [adjusted OR (aOR) 2.12, 95%confidence interval (CI): 1.31-3.75] and plasma HB levels (aOR 0.48, 95%CI: 0.29-0.78) were significantly associated with DE (both P < 0.05). ROC analysis showed that the diagnostic value of Fg or HB alone for DE was limited. The AUC of the combination of both markers as a dual marker index was 0.773 with improved sensitivity (67.7%) and specificity (78.9%) at cutoffs of 3.09 g/L and 126 g/L, respectively.
CONCLUSION The combination of Fg and HB was a reliable predictor of DE. A larger study is needed to confirm the findings.
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Affiliation(s)
- Zheng-Yun Chen
- Department of Gynecology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, Zhejiang Province, China
| | - Li-Feng Zhang
- Department of Gynecology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, Zhejiang Province, China
| | - Yong-Qing Zhang
- Department of Gynecology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, Zhejiang Province, China
| | - Yong Zhou
- Department of Gynecology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, Zhejiang Province, China
| | - Xiao-Yong Li
- Department of Gynecology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, Zhejiang Province, China
| | - Xiu-Feng Huang
- Department of Gynecology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, Zhejiang Province, China
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26
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Velho RV, Taube E, Sehouli J, Mechsner S. Neurogenic Inflammation in the Context of Endometriosis-What Do We Know? Int J Mol Sci 2021; 22:ijms222313102. [PMID: 34884907 PMCID: PMC8658724 DOI: 10.3390/ijms222313102] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/26/2021] [Accepted: 12/01/2021] [Indexed: 12/25/2022] Open
Abstract
Endometriosis (EM) is an estrogen-dependent disease characterized by the presence of epithelial, stromal, and smooth muscle cells outside the uterine cavity. It is a chronic and debilitating condition affecting ~10% of women. EM is characterized by infertility and pain, such as dysmenorrhea, chronic pelvic pain, dyspareunia, dysuria, and dyschezia. Although EM was first described in 1860, its aetiology and pathogenesis remain uncertain. Recent evidence demonstrates that the peripheral nervous system plays an important role in the pathophysiology of this disease. Sensory nerves, which surround and innervate endometriotic lesions, not only drive the chronic and debilitating pain associated with EM but also contribute to a growth phenotype by secreting neurotrophic factors and interacting with surrounding immune cells. Here we review the role that peripheral nerves play in driving and maintaining endometriotic lesions. A better understanding of the role of this system, as well as its interactions with immune cells, will unearth novel disease-relevant pathways and targets, providing new therapeutics and better-tailored treatment options.
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Affiliation(s)
- Renata Voltolini Velho
- Department of Gynecology Charité with Center of Oncological Surgery, Endometriosis Research Center Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany; (R.V.V.); (J.S.)
| | - Eliane Taube
- Institute of Pathology, Charité Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany;
| | - Jalid Sehouli
- Department of Gynecology Charité with Center of Oncological Surgery, Endometriosis Research Center Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany; (R.V.V.); (J.S.)
| | - Sylvia Mechsner
- Department of Gynecology Charité with Center of Oncological Surgery, Endometriosis Research Center Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany; (R.V.V.); (J.S.)
- Correspondence: ; Tel.: +49-030-450664866
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Kapoor R, Stratopoulou CA, Dolmans MM. Pathogenesis of Endometriosis: New Insights into Prospective Therapies. Int J Mol Sci 2021; 22:11700. [PMID: 34769130 PMCID: PMC8583778 DOI: 10.3390/ijms222111700] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/19/2021] [Accepted: 10/19/2021] [Indexed: 02/06/2023] Open
Abstract
Endometriosis is a female reproductive disorder characterized by growth of uterine cells and tissue in distant sites. Around 2-10% of women experience this condition during reproductive age, 35-50% of whom encounter fertility issues or pain. To date, there are no established methods for its early diagnosis and treatment, other than surgical procedures and scans. It is difficult to identify the disease at its onset, unless symptoms such as infertility and/or pain are present. Determining the mechanisms involved in its pathogenesis is vital, not only to pave the way for early identification, but also for disease management and development of less invasive but successful treatment strategies. Endometriosis is characterized by cell proliferation, propagation, evasion of immunosurveillance, and invasive metastasis. This review reports the underlying mechanisms that are individually or collectively responsible for disease establishment and evolution. Treatment of endometriosis mainly involves hormone therapies, which may be undesirable or have their own repercussions. It is therefore important to devise alternative strategies that are both effective and cause fewer side effects. Use of phytochemicals may be one of them. This review focuses on pharmacological inhibitors that can be therapeutically investigated in terms of their effects on signaling pathways and/or mechanisms involved in the pathogenesis of endometriosis.
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Affiliation(s)
- Radhika Kapoor
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1200 Brussels, Belgium; (R.K.); (C.A.S.)
| | - Christina Anna Stratopoulou
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1200 Brussels, Belgium; (R.K.); (C.A.S.)
| | - Marie-Madeleine Dolmans
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1200 Brussels, Belgium; (R.K.); (C.A.S.)
- Gynecology Department, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
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28
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Heard-Lipsmeyer ME, Alhallak I, Simmen FA, Melnyk SB, Simmen RCM. Lesion Genotype Modifies High-Fat Diet Effects on Endometriosis Development in Mice. Front Physiol 2021; 12:702674. [PMID: 34712146 PMCID: PMC8547326 DOI: 10.3389/fphys.2021.702674] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/09/2021] [Indexed: 11/22/2022] Open
Abstract
Endometriosis is a chronic, estrogen-dependent gynecologic disorder that affects reproductive-aged women and to a lesser extent, post-menopausal women on hormone therapy. The condition is associated with systemic and local immune dysfunctions. While its underlying mechanisms remain poorly understood, endometriosis has a genetic component and propensity for the disease is subject to environmental, nutritional, and lifestyle influences. Previously, we showed that high-fat diet (HFD) increased ectopic lesion numbers, concurrent with systemic and peritoneal changes in inflammatory and oxidative stress status, in immunocompetent recipient mice ip administered with endometrial fragments null for Krüppel-like factor 9 gene. Herein, we determined whether HFD modifies lesion parameters, when recipient peritoneal environment is challenged with ectopic wild-type (WT) endometrial fragments, the latter simulating retrograde menstruation common in women during the menstrual period. WT endometrium-recipient mice fed HFD (45% kcal from fat) showed reduced lesion incidence, numbers, and volumes, in the absence of changes in systemic ovarian steroid hormone and insulin levels, relative to those fed the control diet (CD, 17% kcal from fat). Lesions from HFD- and CD-fed recipients demonstrated comparable gene expression for steroid hormone receptors (Esr and Pgr) and cytokines (Il-6, Il-8, and CxCL4) and similar levels of DNA oxidative biomarkers. HFD moderately altered serum (3-nitrotyrosine and methionine/homocysteine) and peritoneal (reduced glutathione/oxidized glutathione) pro-oxidative status but had no effect on peritoneal inflammatory (tumor necrosis factor α and tumor necrosis factor receptor 1) mediators. Results indicate that lesion genotype modifies dietary effects on disease establishment and/or progression and if translated, could be important for provision of nutritional guidelines to women with predisposition to, or affected by endometriosis.
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Affiliation(s)
- Melissa E. Heard-Lipsmeyer
- Department of Physiology and Cell Biology, University of Arkansas for Medical Sciences, Little Rock, AR, United States
- Division of Cell Biology and Physiology, Edward Via College of Osteopathic Medicine-Louisiana, Monroe, LA, United States
| | - Iad Alhallak
- Department of Physiology and Cell Biology, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Frank A. Simmen
- Department of Physiology and Cell Biology, University of Arkansas for Medical Sciences, Little Rock, AR, United States
- The Winthrop P Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Stepan B. Melnyk
- Arkansas Children’s Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Rosalia C. M. Simmen
- Department of Physiology and Cell Biology, University of Arkansas for Medical Sciences, Little Rock, AR, United States
- The Winthrop P Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States
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29
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Loy SL, Zhou J, Cui L, Tan TY, Ee TX, Chern BSM, Chan JKY, Lee YH. Discovery and validation of peritoneal endometriosis biomarkers in peritoneal fluid and serum. Reprod Biomed Online 2021; 43:727-737. [PMID: 34446375 DOI: 10.1016/j.rbmo.2021.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 03/31/2021] [Accepted: 07/07/2021] [Indexed: 12/19/2022]
Abstract
RESEARCH QUESTION What are the potential biomarkers for peritoneal endometriosis in peritoneal fluid and serum? DESIGN Case-control studies composed of independent discovery and validation sets were conducted. In the discovery set, untargeted liquid chromatography-mass spectrometry (LC-MS/MS) metabolomics, multivariable and univariable analyses were conducted to generate global metabolomic profiles of peritoneal fluid for endometriosis and to identify potential metabolites that could distinguish peritoneal endometriosis (n = 10) from controls (n = 31). The identified metabolites from the discovery set were validated in independent peritoneal fluid (n =19 peritoneal endometriosis and n = 20 controls) and serum samples (n = 16 peritoneal endometriosis and n = 19 controls) using targeted metabolomics. The area under the receiver-operating characteristics curve (AUC) analysis was used to evaluate the diagnostic performance of peritoneal endometriosis metabolites. RESULTS In the discovery set, peritoneal fluid phosphatidylcholine (34:3) and phenylalanyl-isoleucine were significantly increased in peritoneal endometriosis groups compared with control groups, with AUC 0.77 (95% CI 0.61 to 0.92; P = 0.018) and AUC 0.98 (95% CI 0.95 to 1.02; P < 0.001), respectively. In the validation set, phenylalanyl-isoleucine retained discriminatory performance to distinguish peritoneal endometriosis from controls in both peritoneal fluid (AUC 0.77, 95% CI 0.61 to 0.92; P = 0.006) and serum samples (AUC 0.81, 95% CI 0.64 to 0.99; P = 0.004), with notably stronger discrimination between peritoneal endometriosis and controls in proliferative phase. CONCLUSION Our preliminary results propose phenylalanyl-isoleucine as a potential biomarker of peritoneal endometriosis, which may be used as a minimally invasive diagnostic biomarker of peritoneal endometriosis.
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Affiliation(s)
- See Ling Loy
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore 229899; Obstetrics and Gynaecology-Academic Clinical Program, Duke-NUS Medical School, Singapore 169857
| | - Jieliang Zhou
- KK Research Centre, KK Women's and Children's Hospital, Singapore 229899
| | - Liang Cui
- KK Research Centre, KK Women's and Children's Hospital, Singapore 229899; Singapore-MIT Alliance for Research and Technology, 1 CREATE Way, #04-13/14 Enterprise Wing, Singapore 138602
| | - Tse Yeun Tan
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore 229899
| | - Tat Xin Ee
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore 229899
| | - Bernard Su Min Chern
- Obstetrics and Gynaecology-Academic Clinical Program, Duke-NUS Medical School, Singapore 169857; Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore 229899
| | - Jerry Kok Yen Chan
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore 229899; Obstetrics and Gynaecology-Academic Clinical Program, Duke-NUS Medical School, Singapore 169857
| | - Yie Hou Lee
- Obstetrics and Gynaecology-Academic Clinical Program, Duke-NUS Medical School, Singapore 169857; KK Research Centre, KK Women's and Children's Hospital, Singapore 229899; Singapore-MIT Alliance for Research and Technology, 1 CREATE Way, #04-13/14 Enterprise Wing, Singapore 138602.
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30
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Wyatt KA, Filby CE, Davies-Tuck ML, Suke SG, Evans J, Gargett CE. Menstrual fluid endometrial stem/progenitor cell and supernatant protein content: cyclical variation and indicative range. Hum Reprod 2021; 36:2215-2229. [PMID: 34173001 DOI: 10.1093/humrep/deab156] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 05/20/2021] [Indexed: 12/13/2022] Open
Abstract
STUDY QUESTION Does natural variation exist in the endometrial stem/progenitor cell and protein composition of menstrual fluid across menstrual cycles in women? SUMMARY ANSWER Limited variation exists in the percentage of some endometrial stem/progenitor cell types and abundance of selected proteins in menstrual fluid within and between a cohort of women. WHAT IS KNOWN ALREADY Menstrual fluid is a readily available biofluid that can represent the endometrial environment, containing endometrial stem/progenitor cells and protein factors. It is unknown whether there is natural variation in the cellular and protein content across menstrual cycles of individual women, which has significant implications for the use of menstrual fluid in research and clinical applications. STUDY DESIGN, SIZE, DURATION Menstrual fluid was collected from 11 non-pregnant females with regular menstrual cycles. Participants had not used hormonal medications in the previous 3 months. Participants collected menstrual fluid samples from up to five cycles using a silicone menstrual cup worn on Day 2 of menstrual bleeding. PARTICIPANTS/MATERIALS, SETTING, METHODS Menstrual fluid samples were centrifuged to separate soluble proteins and cells. Cells were depleted of red blood cells and CD45+ leucocytes. Menstrual fluid-derived endometrial stem/progenitor cells were characterized using multicolour flow cytometry including markers for endometrial stem/progenitor cells N-cadherin (NCAD) and stage-specific embryonic antigen-1 (SSEA-1) (for endometrial epithelial progenitor cells; eEPC), and sushi domain containing-2 (SUSD2) (for endometrial mesenchymal stem cells; eMSC). The clonogenicity of menstrual fluid-derived endometrial cells was assessed using colony forming unit assays. Menstrual fluid supernatant was analyzed using a custom magnetic Luminex assay. MAIN RESULTS AND THE ROLE OF CHANCE Endometrial stem/progenitor cells are shed in menstrual fluid and demonstrate clonogenic properties. The intraparticipant agreement for SUSD2+ menstrual fluid-derived eMSC (MF-eMSC), SSEA-1+ and NCAD+SSEA-1+ MF-eEPC, and stromal clonogenicity were moderate-good (intraclass correlation; ICC: 0.75, 0.56, 0.54 and 0.52, respectively), indicating limited variability across menstrual cycles. Endometrial inflammatory and repair proteins were detectable in menstrual fluid supernatant, with five of eight (63%) factors demonstrating moderate intraparticipant agreement (secretory leukocyte protein inhibitor (SLPI), lipocalin-2 (NGAL), lactoferrin, follistatin-like 1 (FSTL1), human epididymis protein-4 (HE4); ICC ranges: 0.57-0.69). Interparticipant variation was limited for healthy participants, with the exception of key outliers of which some had self-reported menstrual pathologies. LARGE SCALE DATA N/A. There are no OMICS or other data sets relevant to this study. LIMITATIONS, REASONS FOR CAUTION The main limitations to this research relate to the difficulty of obtaining menstrual fluid samples across multiple menstrual cycles in a consistent manner. Several participants could only donate across <3 cycles and the duration of wearing the menstrual cup varied between 4 and 6 h within and between women. Due to the limited sample size used in this study, wider studies involving multiple consecutive menstrual cycles and a larger cohort of women will be required to fully determine the normal range of endometrial stem/progenitor cell and supernatant protein content of menstrual fluid. Possibility for selection bias and true representation of the population of women should also be considered. WIDER IMPLICATIONS OF THE FINDINGS Menstrual fluid is a reliable source of endometrial stem/progenitor cells and related endometrial proteins with diagnostic potential. The present study indicates that a single menstrual sample may be sufficient in characterizing a variety of cellular and protein parameters across women's menstrual cycles. The results also demonstrate the potential of menstrual fluid for identifying endometrial and menstrual abnormalities in both research and clinical settings as a non-invasive method for assessing endometrial health. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by grants from the Australian National Health and Medical Research Council to C.E.G. (Senior Research Fellowship 1024298 and Investigator Fellowship 1173882) and to J.E. (project grant 1047756), the Monash IVF Research Foundation to C.E.G. and the Victorian Government's Operational Infrastructure Support Program. K.A.W., M.L.D.-T., S.G.S. and J.E. declare no conflicts of interest. C.E.G. reports grants from NHMRC, during the conduct of the study; grants from EndoFound USA, grants from Ferring Research Innovation, grants from United States Department of Defence, grants from Clue-Utopia Research Foundation, outside the submitted work. CEF reports grants from EndoFound USA, grants from Clue-Utopia Research Foundation, outside the submitted work.
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Affiliation(s)
- K A Wyatt
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, 3168 VIC, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, 3168 VIC, Australia
| | - C E Filby
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, 3168 VIC, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, 3168 VIC, Australia
| | - M L Davies-Tuck
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, 3168 VIC, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, 3168 VIC, Australia
| | - S G Suke
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, 3168 VIC, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, 3168 VIC, Australia
| | - J Evans
- Department of Obstetrics and Gynaecology, Monash University, Clayton, 3168 VIC, Australia.,Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, 3168 VIC, Australia
| | - C E Gargett
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, 3168 VIC, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, 3168 VIC, Australia
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Large scale cytokine profiling uncovers elevated IL12-p70 and IL-17A in severe pediatric acute respiratory distress syndrome. Sci Rep 2021; 11:14158. [PMID: 34239039 PMCID: PMC8266860 DOI: 10.1038/s41598-021-93705-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/28/2021] [Indexed: 01/20/2023] Open
Abstract
The specific cytokines that regulate pediatric acute respiratory distress syndrome (PARDS) pathophysiology remains unclear. Here, we evaluated the respiratory cytokine profile in PARDS to identify the molecular signatures associated with severe disease. A multiplex suspension immunoassay was used to profile 45 cytokines, chemokines and growth factors. Cytokine concentrations were compared between severe and non-severe PARDS, and correlated with oxygenation index (OI). Partial least squares regression modelling and regression coefficient plots were used to identify a composite of key mediators that differentially segregated severe from non-severe disease. The mean (standard deviation) age and OI of this cohort was 5.2 (4.9) years and 17.8 (11.3), respectively. Early PARDS patients with severe disease exhibited a cytokine signature that was up-regulated for IL-12p70, IL-17A, MCP-1, IL-4, IL-1β, IL-6, MIP-1β, SCF, EGF and HGF. In particular, pro-inflammatory cytokines (IL-6, MCP-1, IP-10, IL-17A, IL-12p70) positively correlated with OI early in the disease. Whereas late PARDS was characterized by a differential lung cytokine signature consisting of both up-regulated (IL-8, IL-12p70, VEGF-D, IL-4, GM-CSF) and down-regulated (IL-1β, EGF, Eotaxin, IL-1RA, and PDGF-BB) profiles segregating non-severe and severe groups. This cytokine signature was associated with increased transcription, T cell activation and proliferation as well as activation of mitogen-activated protein kinase pathway that underpin PARDS severity.
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Eleutério J, das Chagas Medeiros F. Peritoneal lavage cytology in the diagnosis of pelvic endometriosis. Diagn Cytopathol 2021; 49:677-681. [PMID: 33555651 DOI: 10.1002/dc.24721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/25/2021] [Accepted: 01/28/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND We aimed to assess the sensibility, specificity, and predictive values of cytology of the fluid sediment in patients with pelvic endometriosis diagnosed based on laparoscopic-guided biopsy. METHODS Between January 2017 and September 2018, 71 specimens of peritoneal fluid collected by laparoscopy were evaluated. Fifty-three patients were diagnosed laparoscopically and histologically with endometriosis, and 18 were considered controls (without suspicious endometriosis lesions). We calculated the sensitivity, specificity, the positive and negative predictive value, and the accuracy of endometrial-like cells (ELC) and hemosiderin-laden macrophages (HLM) in the fluid sediment. RESULTS Of the 50 patients with endometriosis, 32 (64%) had HLM, 9 (18%) had ELC, and 7 (14%) had both elements. Of the 18 patients without endometriosis, 3 (16%) had HLM, 2 (11%) had ELC, and 1 (5%) had both ELC and HLM. The sensitivity of the cytology of peritoneal fluid sediment for the diagnosis of endometriosis, based on the presence of ELC, was 18%, the specificity was 83%, the positive predictive value was 82%, the negative predictive value was 28.7%, and the accuracy was 36.8%. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy based on the presence of HLM were 64%, 83%, 91%, 45.5%, and 69.1%, respectively. CONCLUSION The study of peritoneal fluids obtained laparoscopically from women undergoing evaluation for endometriosis may identify patients with the disease.
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Affiliation(s)
- José Eleutério
- Department of the Health of Women, Children, and Adolescents, Federal University of Ceará, Ceará, Brazil
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Jiang Y, Xin X, Pan X, Zhang A, Zhang Z, Li J, Yuan X. STAT4 targets KISS1 to promote the apoptosis of ovarian granulosa cells. J Ovarian Res 2020; 13:135. [PMID: 33218349 PMCID: PMC7679982 DOI: 10.1186/s13048-020-00741-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 11/12/2020] [Indexed: 12/14/2022] Open
Abstract
Background In mammals, it is known that the estradiol-17β (E2) is mainly synthetized in ovarian granulosa cells (GCs), and the excessive apoptosis of GCs induces the follicular atresia. Many studies have implicated the essential role of KISS1, with the pro-synthetic effect of E2 and the anti-apoptotic effect on GCs, in the mammalian folliculogenesis, and several STAT4 potential binding sites were previously predicted on the promoter of KISS1 in pigs. However, the biological effects of STAT4 on GCs and the molecular regulation between STAT4 and KISS1 remained largely unknown. Methods Using the porcine GCs as the cellular model, the overexpression plasmid, small interfering RNA, 5′-deletion and luciferase assay were applied to investigate the molecular mechanisms for STAT4 regulating the expression of KISS1. Results In this study, the STAT4 negatively regulated the mRNA and protein levels of KISS1 in porcine GCs, and the mRNA level of STAT4 was observed to significantly decrease from immature to mature follicles, which was inversed with that of KISS1. The relative luciferase activity of KISS1 promoter was significantly increased with deletion of the fourth potential binding site (− 305/− 295), and ChIP further confirmed that the STAT4 bound at − 305/− 295 region of KISS1. Besides, the STAT4 significantly regulated the mRNA levels of PDK1, FOXO3 and TSC2 of PI3K signaling pathway to promote the cell apoptosis and the percentage of cells at G0/G1 phase of cell cycle in GCs. Alternatively, the STAT4 significantly decreased the mRNA levels of CYP17, 3B-HSD, 17B-33 HSD, ESR1, and ESR2, as well as the concentration of E2 in GCs. Furthermore, interfering with the expression of STAT4 was observed to significantly stimulate the pro-synthetic effect of E2 and anti-apoptotic effect of KISS1 in GCs. Conclusions Collectively, the STAT4 might directly target at − 305/− 295 region of KISS1 to negatively regulate the transcription of KISS1, promote the cell apoptosis via PI3K signaling pathway, suppress the synthesis of E2 through the estrogen signaling pathway in porcine GCs. These proposed works could provide useful insight in further investigations on the molecular functionalities of STAT4 and KISS1 in the folliculogenesis of mammals.
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Affiliation(s)
- Yao Jiang
- Guangdong Provincial Key Lab of Agro-Animal Genomics and Molecular Breeding, National Engineering Research Centre for Breeding Swine Industry, College of Animal Science, South China Agricultural University, Guangzhou, Guangdong, China.,Guangdong Provincial Key Laboratory of Laboratory Animals, Guangdong Laboratory Animals Monitoring Institute, Guangzhou, Guangdong, China
| | - Xiaoping Xin
- Guangdong Provincial Key Lab of Agro-Animal Genomics and Molecular Breeding, National Engineering Research Centre for Breeding Swine Industry, College of Animal Science, South China Agricultural University, Guangzhou, Guangdong, China
| | - Xiangchun Pan
- Guangdong Provincial Key Lab of Agro-Animal Genomics and Molecular Breeding, National Engineering Research Centre for Breeding Swine Industry, College of Animal Science, South China Agricultural University, Guangzhou, Guangdong, China
| | - Ailing Zhang
- College of Biology and Food Engineering/Development, Center of Applied Ecology and Ecological Engineering in Universities, Guangdong University of Education, Guangzhou, 510303, China
| | - Zhe Zhang
- Guangdong Provincial Key Lab of Agro-Animal Genomics and Molecular Breeding, National Engineering Research Centre for Breeding Swine Industry, College of Animal Science, South China Agricultural University, Guangzhou, Guangdong, China
| | - Jiaqi Li
- Guangdong Provincial Key Lab of Agro-Animal Genomics and Molecular Breeding, National Engineering Research Centre for Breeding Swine Industry, College of Animal Science, South China Agricultural University, Guangzhou, Guangdong, China.
| | - Xiaolong Yuan
- Guangdong Provincial Key Lab of Agro-Animal Genomics and Molecular Breeding, National Engineering Research Centre for Breeding Swine Industry, College of Animal Science, South China Agricultural University, Guangzhou, Guangdong, China. .,Guangdong Provincial Key Laboratory of Laboratory Animals, Guangdong Laboratory Animals Monitoring Institute, Guangzhou, Guangdong, China.
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Maddern J, Grundy L, Castro J, Brierley SM. Pain in Endometriosis. Front Cell Neurosci 2020; 14:590823. [PMID: 33132854 PMCID: PMC7573391 DOI: 10.3389/fncel.2020.590823] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 09/15/2020] [Indexed: 12/15/2022] Open
Abstract
Endometriosis is a chronic and debilitating condition affecting ∼10% of women. Endometriosis is characterized by infertility and chronic pelvic pain, yet treatment options remain limited. In many respects this is related to an underlying lack of knowledge of the etiology and mechanisms contributing to endometriosis-induced pain. Whilst many studies focus on retrograde menstruation, and the formation and development of lesions in the pathogenesis of endometriosis, the mechanisms underlying the associated pain remain poorly described. Here we review the recent clinical and experimental evidence of the mechanisms contributing to chronic pain in endometriosis. This includes the roles of inflammation, neurogenic inflammation, neuroangiogenesis, peripheral sensitization and central sensitization. As endometriosis patients are also known to have co-morbidities such as irritable bowel syndrome and overactive bladder syndrome, we highlight how common nerve pathways innervating the colon, bladder and female reproductive tract can contribute to co-morbidity via cross-organ sensitization.
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Affiliation(s)
- Jessica Maddern
- Visceral Pain Research Group, College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
- Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Luke Grundy
- Visceral Pain Research Group, College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
- Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Joel Castro
- Visceral Pain Research Group, College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
- Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Stuart M. Brierley
- Visceral Pain Research Group, College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
- Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Discipline of Medicine, University of Adelaide, North Terrace Campus, Adelaide, SA, Australia
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CD200 and CD200R Expression on Peripheral Blood Lymphocytes and Serum CD200 Concentration as a New Marker of Endometriosis. J Clin Med 2020; 9:jcm9093035. [PMID: 32967175 PMCID: PMC7564549 DOI: 10.3390/jcm9093035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/11/2020] [Accepted: 09/17/2020] [Indexed: 12/13/2022] Open
Abstract
The causes of endometriosis (EMS) remain unknown; however, a number of immunological abnormalities contribute to the pathogenesis of the disease. The cluster of differentiation-200 (CD200) and its receptor (CD200R) maintain peripheral self-tolerance by negatively regulating immune responses. In this comparative cross-sectional study, we investigated the expression of CD200 and CD200R on T and B lymphocytes and the serum level of soluble CD200 (sCD200) using flow cytometry and ELISA, respectively. Peripheral blood samples were collected from 54 female patients and 20 healthy, age-matched controls. Results were tested for correlation with disease severity and selected clinical parameters. We demonstrated that the differences in sCD200 levels (p = 0.001), the frequencies of CD200-positive T and B lymphocytes (p < 0.001 and p = 0.004, respectively), and the frequencies of CD200R-positive T and B lymphocytes (p < 0.001 for all comparisons) in the study group correlated positively with disease severity. Receiver operating characteristic (ROC) analysis indicated that aberrant expression of CD200/CD200R might serve as a marker to distinguish between EMS cases. Finally, negative co-stimulatory factors may contribute to the induction and persistence of inflammation associated with EMS. It seems that it is essential to determine whether alteration in the CD200/CD200R pathway can be therapeutically targeted in EMS.
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