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Hon JX, Wahab NA, Karim AKA, Mokhtar NM, Mokhtar MH. MicroRNAs in Endometriosis: Insights into Inflammation and Progesterone Resistance. Int J Mol Sci 2023; 24:15001. [PMID: 37834449 PMCID: PMC10573326 DOI: 10.3390/ijms241915001] [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: 09/10/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 10/15/2023] Open
Abstract
Endometriosis, a non-malignant gynecological disorder influenced by estrogen, involves the growth of endometrial tissue outside the uterus. Its development includes processes such as inflammation, progesterone resistance, angiogenesis, and cell proliferation. Epigenetic factors, particularly the dysregulation of microRNAs (miRNAs), have emerged as key factors in these mechanisms in endometriosis. This review aims to unveil the intricate molecular processes that control inflammation, progesterone resistance, and miRNA functions in endometriosis. In addition, it provides a comprehensive overview of the current understanding regarding the involvement of miRNAs in the inflammatory aspects of this condition. This synthesis encompasses research investigating the molecular underpinnings of inflammation, along with the biogenesis and roles of miRNAs in endometriosis. Furthermore, it examines human studies and functional analyses to establish the intricate connection between miRNAs, inflammation, and progesterone resistance in the context of endometriosis. The results highlight the significant impact of dysregulated miRNAs on the inflammatory pathways and hormonal imbalances characteristic of endometriosis. Consequently, miRNAs hold promise as potential non-invasive biomarkers and targeted therapeutic agents aimed at addressing inflammation and enhancing the response to progesterone treatment in individuals with endometriosis.
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Affiliation(s)
- Jing-Xian Hon
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Norhazlina Abdul Wahab
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
- GUT Research Group, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Abdul Kadir Abdul Karim
- Department of Obstetrics & Gynecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Norfilza Mohd Mokhtar
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
- GUT Research Group, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Mohd Helmy Mokhtar
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
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Correa FJS, Andres MP, Rocha TP, Carvalho AEZ, Aloia TPA, Corpa MVN, Kallas EG, Mangueira CLP, Baracat EC, Carvalho KI, Abrão MS. Invariant Natural Killer T-cells and their subtypes may play a role in the pathogenesis of endometriosis. Clinics (Sao Paulo) 2022; 77:100032. [PMID: 35576870 PMCID: PMC9118517 DOI: 10.1016/j.clinsp.2022.100032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/11/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To evaluate the frequencies of iNKT cells and their subsets in patients with deep endometriosis. METHODS A case-control study was conducted between 2013 and 2015, with 73 patients distributed into two groups: 47 women with a histological diagnosis of endometriosis and 26 controls. Peripheral blood, endometriosis lesions, and healthy peritoneal samples were collected on the day of surgery to determine the frequencies of iNKT cells and subtypes via flow cytometry analysis. RESULTS The authors observed a lower number of iNKT (p = 0.01) and Double-Negative (DN) iNKT cells (p = 0.02) in the blood of patients with endometriosis than in the control group. The number of DN iNKT IL-17+ cells in the secretory phase was lower in the endometriosis group (p = 0.049). There was an increase in the secretion of IL-17 by CD4+ iNKT cells in the blood of patients with endometriosis and severe dysmenorrhea (p = 0.038), and severe acyclic pelvic pain (p = 0.048). Patients with severe dysmenorrhea also had a decreased number of CD4+ CCR7+ cells (p = 0.022). CONCLUSION The decreased number of total iNKT and DN iNKT cells in patients with endometriosis suggests that iNKT cells play a role in the pathogenesis of endometriosis and can be used to develop new diagnostic and therapeutic agents.
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Affiliation(s)
- Frederico J S Correa
- Endometriosis Section, Divisão de Clínica Ginecológica, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil; Gynecology and Obstetrics Department, Faculdade de Medicina da Universidade de Brasília (UnB), Campus Universitário Darcy Ribeiro, Brasília, DF, Brazil
| | - Marina Paula Andres
- Endometriosis Section, Divisão de Clínica Ginecológica, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil; Gynecologic Division, BP ‒ A Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil
| | - Tainá Pezzin Rocha
- Endometriosis Section, Divisão de Clínica Ginecológica, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Ana Eduarda Z Carvalho
- Laboratório de Pesquisa e Desenvolvimento Peter Murányi, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Thiago P A Aloia
- Laboratório de Pesquisa e Desenvolvimento Peter Murányi, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Marcus V N Corpa
- Laboratório de Medicina Diagnóstica e Preventiva, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Esper G Kallas
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Cristóvão L P Mangueira
- Laboratório de Pesquisa e Desenvolvimento Peter Murányi, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Edmund C Baracat
- Endometriosis Section, Divisão de Clínica Ginecológica, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Karina I Carvalho
- Laboratório de Pesquisa e Desenvolvimento Peter Murányi, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Mauricio S Abrão
- Endometriosis Section, Divisão de Clínica Ginecológica, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil; Gynecologic Division, BP ‒ A Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil.
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Biomarkers for the Noninvasive Diagnosis of Endometriosis: State of the Art and Future Perspectives. Int J Mol Sci 2020; 21:ijms21051750. [PMID: 32143439 PMCID: PMC7084761 DOI: 10.3390/ijms21051750] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/27/2020] [Accepted: 03/02/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Early and accurate diagnosis of endometriosis is crucial for the management of this benign, yet debilitating pathology. Despite the advances of modern medicine, there is no common ground regarding the pathophysiology of this disease as it continues to affect the quality of life of millions of women of reproductive age. The lack of specific symptoms often determines a belated diagnosis. The gold standard remains invasive, surgery followed by a histopathological exam. A biomarker or a panel of biomarkers is easy to measure, usually noninvasive, and could benefit the clinician in both diagnosing and monitoring the treatment response. Several studies have advanced the idea of biomarkers for endometriosis, thereby circumventing unnecessary invasive techniques. Our paper aims at harmonizing the results of these studies in the search of promising perspectives on early diagnosis. METHODS We selected the papers from Google Academic, PubMed, and CrossRef and reviewed recent articles from the literature, aiming to evaluate the effectiveness of various putative serum and urinary biomarkers for endometriosis. RESULTS The majority of studies focused on a panel of biomarkers, rather than a single biomarker and were unable to identify a single biomolecule or a panel of biomarkers with sufficient specificity and sensitivity in endometriosis. CONCLUSION Noninvasive biomarkers, proteomics, genomics, and miRNA microarray may aid the diagnosis, but further research on larger datasets along with a better understanding of the pathophysiologic mechanisms are needed.
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Vallvé-Juanico J, Houshdaran S, Giudice LC. The endometrial immune environment of women with endometriosis. Hum Reprod Update 2019; 25:564-591. [PMID: 31424502 PMCID: PMC6737540 DOI: 10.1093/humupd/dmz018] [Citation(s) in RCA: 220] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 03/07/2019] [Accepted: 04/18/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Endometriosis, a common oestrogen-dependent inflammatory disorder in women of reproductive age, is characterized by endometrial-like tissue outside its normal location in the uterus, which causes pelvic scarring, pain and infertility. While its pathogenesis is poorly understood, the immune system (systemically and locally in endometrium, pelvic endometriotic lesions and peritoneal fluid) is believed to play a central role in its aetiology, pathophysiology and associated morbidities of pain, infertility and poor pregnancy outcomes. However, immune cell populations within the endometrium of women with the disease have had incomplete phenotyping, thereby limiting insight into their roles in this disorder. OBJECTIVE AND RATIONALE The objective herein was to determine reproducible and consistent findings regarding specific immune cell populations and their abundance, steroid hormone responsiveness, functionality, activation states, and markers, locally and systemically in women with and without endometriosis. SEARCH METHODS A comprehensive English language PubMed, Medline and Google Scholar search was conducted with key search terms that included endometriosis, inflammation, human eutopic/ectopic endometrium, immune cells, immune population, immune system, macrophages, dendritic cells (DC), natural killer cells, mast cells, eosinophils, neutrophils, B cells and T cells. OUTCOMES In women with endometriosis compared to those without endometriosis, some endometrial immune cells display similar cycle-phase variation, whereas macrophages (Mø), immature DC and regulatory T cells behave differently. A pro-inflammatory Mø1 phenotype versus anti-inflammatory Mø2 phenotype predominates and natural killer cells display abnormal activity in endometrium of women with the disease. Conflicting data largely derive from small studies, variably defined hormonal milieu and different experimental approaches and technologies. WIDER IMPLICATIONS Phenotyping immune cell subtypes is essential to determine the role of the endometrial immune niche in pregnancy and endometrial homeostasis normally and in women with poor reproductive history and can facilitate development of innovative diagnostics and therapeutics for associated symptoms and compromised reproductive outcomes.
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Affiliation(s)
- Júlia Vallvé-Juanico
- Department of Gynecology, IVI Barcelona S.L., 08017, Barcelona, Spain
- Group of Biomedical Research in Gynecology, Vall Hebron Research Institute (VHIR) and University Hospital, 08035, Barcelona, Spain
- Universitat Autònoma de Barcelona, 08193, Bellaterra (Barcelona), Spain
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA 94193, USA
| | - Sahar Houshdaran
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA 94193, USA
| | - Linda C Giudice
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA 94193, USA
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Králíčková M, Fiala L, Losan P, Tomes P, Vetvicka V. Altered Immunity in Endometriosis: What Came First? Immunol Invest 2018; 47:569-582. [DOI: 10.1080/08820139.2018.1467926] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Milena Králíčková
- Department of Histology and Embryology, Faculty of Medicine, Charles University, Plzen, Czech Republic
- Department of Obstetrics and Gynecology, University Hospital, Faculty of Medicine, Charles University, Plzen, Czech Republic
- Biomedical Centre, Faculty of Medicine in Plzen, Charles University, Plzen, Czech Republic
| | - Ludek Fiala
- Institute of Sexology First Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Psychiatry, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
| | - Petr Losan
- Department of Histology and Embryology, Faculty of Medicine, Charles University, Plzen, Czech Republic
| | - Pavel Tomes
- Department of Obstetrics and Gynecology, University Hospital, Faculty of Medicine, Charles University, Plzen, Czech Republic
| | - Vaclav Vetvicka
- Department of Pathology, University of Louisville, Louisville, KY, USA
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Tumor Necrosis Factor and its Soluble Receptors as Potential Diagnostic Markers of Endometriosis. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2017. [DOI: 10.5301/jeppd.5000306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction Tumor necrosis factor (TNF) is a proinflammatory and angiogenic factor produced by activated macrophages. TNF acts through the cell membrane receptors TNFR1 and TNFR2, whose soluble forms play an important role in regulating TNF activity through competition with its receptors. The aim of this study was to evaluate whether TNF and/or its soluble receptors are useful to detect endometriosis in women undergoing laparoscopy for gynecological complains. Methods This was a prospective, controlled, cross-sectional study including 75 consecutive women scheduled for gynecological laparoscopy due to chronic pelvic pain, infertility, or a pelvic image suggestive of endometrioma. Plasma TNF and soluble TNF receptors (sTNFR1 and sTNFR2) were measured by flow cytometry with the Cytometric Bead Array Human TH1/TH2 Kit (BD Biosciences). Results Women ultimately proven to have endometriosis had lower preoperative plasma levels of sTNFR1 (median 81 pg/mL vs. 121 pg/mL, p<0.05), resulting in higher TNF/sTNFR1 ratios compared to those without endometriosis (0.055 vs. 0.033, p<0.05). Using the cut-off <108 pg/mL for plasma sTNFR1 to detect endometriosis in this setting, the sensitivity was 51.6% (95% confidence interval [CI], 35%-68%), the specificity was 75.0% (95% CI, 61%-85%) and the positive likelihood ratio was 2.1 (95% CI, 1.1-3.8). The area under the ROC curve was 0.647 (SE = 0.065; 95% CI, 0.519-0.774; p = 0.031). Conclusions Plasma sTNFR1 levels are lower in symptomatic women with confirmed endometriosis compared to symptomatic women without endometriosis. The lower plasma sTNFR1 levels may increase the bioavailability of TNF, thereby contributing to the systemic low grade inflammation associated with endometriosis.
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