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Sisnett DJ, Zutautas KB, Miller JE, Lingegowda H, Ahn SH, McCallion A, Bougie O, Lessey BA, Tayade C. The Dysregulated IL-23/TH17 Axis in Endometriosis Pathophysiology. J Immunol 2024; 212:1428-1441. [PMID: 38466035 DOI: 10.4049/jimmunol.2400018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 02/26/2024] [Indexed: 03/12/2024]
Abstract
Endometriosis is a chronic inflammatory disease in which endometrial-like tissue grows ectopically, resulting in pelvic pain and infertility. IL-23 is a key contributor in the development and differentiation of TH17 cells, driving TH17 cells toward a pathogenic profile. In a variety of inflammatory and autoimmune disorders, TH17 cells secrete proinflammatory cytokines, including IL-17, contributing to disease pathophysiology. Our studies and others have implicated IL-17 and TH17 cell dysregulation in endometriosis, which is associated with disease severity. In this article, we address whether IL-23-driven TH17 cells contribute to cardinal features of lesion proliferation, vascularization, and inflammation in endometriosis using patient samples, representative cell lines, and our established mouse model of endometriosis. The results indicated dysregulated expression of key genes in the IL-23/TH17 axis in patient ectopic and eutopic endometrial samples and increased IL-23 protein in patient plasma compared with controls. In vitro studies using primary human TH cells determined that rIL-23 mixture treatment increased pathogenic TH17 cell frequency. Similarly, rIL-23 treatment of cell lines (12Z cells, EECCs, HUVECs, and hESCs) representative of the endometriotic lesion microenvironment increased cytokines and growth factors, which play a role in lesion establishment and maintenance. In a syngeneic mouse model of endometriosis, rIL-23 treatment altered numbers of myeloid and T cell subsets in peritoneal fluid and increased giant cells within the lesion. Lesions from rIL-23-treated mice did not reveal significant alterations in proliferation/vascularization, although trends of increased proliferation and vascularization were observed. Collectively, these findings provide insights into the impact of the IL-23/TH17 axis on local immune dysfunction and broadly on endometriosis pathophysiology.
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Affiliation(s)
- Danielle J Sisnett
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Katherine B Zutautas
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Jessica E Miller
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | | | - Soo Hyun Ahn
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Alison McCallion
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Olga Bougie
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
- Department of Obstetrics and Gynaecology, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Bruce A Lessey
- School of Medicine, Wake Forest University, Winston-Salem, NC
| | - Chandrakant Tayade
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
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Canis M, Abbott J, Abrao M, Al-Jefout M, Bedaiwy M, Benagiano G, Burns KA, Canis M, Carmona F, Chapron C, Critchley HO, de Ziegler D, Falcone T, Fazleabas A, Ferrero S, Garcia-Velasco JA, Gargett C, Greaves E, Griffith LG, Guo SW, Habiba M, Harada T, Hull ML, Johnson NP, Kaufman Y, Issacson KB, Khan KN, Kim MR, Koninckx PA, Lessey BA, Martin D, Matsuzaki S, Mishra G, Osuga Y, Petraglia F, Popov A, Roman H, Romano A, Saunders P, Seckin T, Somigliana E, Taylor HS, Taylor RN, Vercellini P, Vigano P. A Call for New Theories on the Pathogenesis and Pathophysiology of Endometriosis. J Minim Invasive Gynecol 2024; 31:371-377. [PMID: 38365066 DOI: 10.1016/j.jmig.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/31/2024] [Accepted: 02/04/2024] [Indexed: 02/18/2024]
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Li R, Tran DN, Lessey BA, Young SL, Kim TH, Jeong JW. Transcriptomic changes in eutopic endometrium and ectopic lesions during endometriosis progression in a mouse model. F S Sci 2024:S2666-335X(24)00014-4. [PMID: 38342342 DOI: 10.1016/j.xfss.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/23/2024] [Accepted: 02/01/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVE To identify the transcriptomic changes of ectopic lesions and eutopic endometrial tissues during the progression of endometriosis, we performed transcriptomic analysis in the eutopic endometrium and ectopic lesions. DESIGN Laboratory study. SETTING Academic medical center. ANIMALS Four fertile and 4 subfertile Pgrcre/+Rosa26mTmG/+ mice with endometriosis, and 4 sham mice for each group of endometriosis mice as control. These mice underwent either surgery to induce endometriosis or sham surgery. Fertile sham and mice with endometriosis were used 1 month after surgery, whereas subfertile ones were used 3 months after surgery. INTERVENTIONS Early and chronic effects of endometriosis on transcriptomics of ectopic lesions and eutopic endometrium. MAIN OUTCOME MEASURES RNA-sequencing analysis and identification of differentially expressed genes and pathways in the ectopic lesions and eutopic uteri from mice with endometriosis and sham mice at day 3.5 of pregnancy. RESULTS Our mouse model recapitulates the transcriptomic changes of ectopic lesions in humans. RNA-sequencing analysis was performed in ectopic lesions and eutopic uteri from mice with or without endometriosis during the progression of the disease. Estrogen activity, inflammation, angiogenesis, and fibrosis pathways were consistently elevated in all the ectopic lesions compared with eutopic endometrium. Cholesterol/glucose synthesis and stem cell pluripotency pathways were more enhanced in ectopic lesions from subfertile mice compared with their eutopic endometrium. Dysregulation of infiltration of macrophage, dendritic, T and B cells was validated with the use of immunohistochemistry in ectopic lesions. Multiple ligand-receptor pairs between the ectopic and eutopic endometrium were altered compared with the sham endometrium. Suppressed WNT and EGF pathways were only found in the eutopic endometrium from subfertile not fertile mice compared with sham. CONCLUSIONS Our mouse endometriosis model recapitulates the transcriptomics of ectopic lesions in humans. Our transcriptomic analysis during endometriosis progression in our mouse model will help us understand the pathophysiology of endometriosis.
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Affiliation(s)
- Rong Li
- Department of Obstetrics, Gynecology and Women's Health, University of Missouri, Columbia, Missouri
| | - Dinh Nam Tran
- Department of Obstetrics, Gynecology and Women's Health, University of Missouri, Columbia, Missouri
| | - Bruce A Lessey
- Department of Obstetrics and Gynecology, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Steven L Young
- Department of Obstetrics, Gynecology and Women's Health, Duke University, Durham, North Carolina
| | - Tae Hoon Kim
- Department of Obstetrics, Gynecology and Women's Health, University of Missouri, Columbia, Missouri
| | - Jae-Wook Jeong
- Department of Obstetrics, Gynecology and Women's Health, University of Missouri, Columbia, Missouri.
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Marquardt RM, Tran DN, Lessey BA, Rahman MS, Jeong JW. Epigenetic Dysregulation in Endometriosis: Implications for Pathophysiology and Therapeutics. Endocr Rev 2023; 44:1074-1095. [PMID: 37409951 PMCID: PMC10638603 DOI: 10.1210/endrev/bnad020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 02/15/2023] [Accepted: 07/05/2023] [Indexed: 07/07/2023]
Abstract
Endometriosis is a prevalent gynecological condition associated with pelvic pain and infertility. Despite more than a century of research, the etiology of endometriosis still eludes scientific consensus. This lack of clarity has resulted in suboptimal prevention, diagnosis, and treatment options. Evidence of genetic contributors to endometriosis is interesting but limited; however, significant progress has been made in recent years in identifying an epigenetic role in the pathogenesis of endometriosis through clinical studies, in vitro cell culture experiments, and in vivo animal models. The predominant findings include endometriosis-related differential expression of DNA methyltransferases and demethylases, histone deacetylases, methyltransferases, and demethylases, and regulators of chromatin architecture. There is also an emerging role for miRNAs in controlling epigenetic regulators in the endometrium and endometriosis. Changes in these epigenetic regulators result in differential chromatin organization and DNA methylation, with consequences for gene expression independent of a genetic sequence. Epigenetically altered expression of genes related to steroid hormone production and signaling, immune regulation, and endometrial cell identity and function have all been identified and appear to play into the pathophysiological mechanisms of endometriosis and resulting infertility. This review summarizes and critically discusses early seminal findings, the ever-growing recent evidence of epigenetic contributions to the pathophysiology of endometriosis, and implications for proposed epigenetically targeted therapeutics.
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Affiliation(s)
- Ryan M Marquardt
- Department of Obstetrics, Gynecology & Reproductive Biology, Michigan State University, Grand Rapids, MI, USA
| | - Dinh Nam Tran
- Department of Obstetrics, Gynecology and Women's Health, University of Missouri, Columbia, MO, USA
| | - Bruce A Lessey
- Department of Obstetrics and Gynecology, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Md Saidur Rahman
- Department of Obstetrics, Gynecology and Women's Health, University of Missouri, Columbia, MO, USA
| | - Jae-Wook Jeong
- Department of Obstetrics, Gynecology and Women's Health, University of Missouri, Columbia, MO, USA
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Giudice LC, As-Sanie S, Arjona Ferreira JC, Becker CM, Abrao MS, Lessey BA, Dynowski K, Wilk K, Li Y, Mathur V, Wagman RB, Johnson NP. A Plain Language Summary to learn about relugolix combination therapy for the treatment of pain associated with endometriosis. Pain Manag 2023; 13:631-640. [PMID: 37982388 DOI: 10.2217/pmt-2023-0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023] Open
Abstract
WHAT IS THIS SUMMARY ABOUT? This is a summary of research studies (known as clinical trials) called SPIRIT 1 and SPIRIT 2. The SPIRIT 1 and SPIRIT 2 studies compared how well a medicine called relugolix combination therapy worked in relieving pain in women with moderate to severe endometriosis compared to a placebo, a pill with no active medication. Endometriosis occurs when tissue similar to what normally lines the uterus grows in other places, such as the ovaries, fallopian tubes, and bowels. WHAT WERE THE RESULTS? Researchers looked at 1261 adult women with moderate to severe endometriosis. Randomly, 420 (33%) of these women were assigned to relugolix combination therapy, 420 (33%) were assigned to delayed relugolix combination therapy (relugolix alone first and then relugolix combination therapy for the remainder of the study), and 421 (33%) were assigned to placebo. The SPIRIT 1 and SPIRIT 2 studies showed that more women taking relugolix combination therapy (75% from SPIRIT 1 and 75% from SPIRIT 2) for 24 weeks had both less pelvic or groin pain during menstrual periods from endometriosis and no need for more pain medicines than women who took placebo (27% from SPIRIT 1 and 30% from SPIRIT 2). The SPIRIT 1 and SPIRIT 2 studies also showed that more women taking relugolix combination therapy (59% from SPIRIT 1 and 66% from SPIRIT 2) for 24 weeks had both less pelvic or groin pain between menstrual periods from endometriosis and no need for more pain medicines than women who took placebo (40% from SPIRIT 1 and 43% from SPIRIT 2). Women taking relugolix combination therapy had less pelvic or groin pain during and between menstrual periods within 4 weeks of starting the medicine. The most common side effects were headaches, the common cold, and hot flushes or feeling hot among women taking relugolix combination therapy, delayed relugolix combination therapy, and placebo. Relugolix combination therapy was considered safe for those with no major medical problems. Women taking relugolix combination therapy had little to no loss of bone mineral density (a way of knowing how strong bones are) after 24 weeks of treatment. WHAT DO THE RESULTS OF THESE STUDIES TELL US? Women with moderate to severe endometriosis taking relugolix combination therapy had much less pain from endometriosis than women taking placebo. Clinical Trial Registration: NCT03204318 (SPIRIT-1); NCT03204331 (SPIRIT-2) (ClinicalTrials.gov).
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Affiliation(s)
- Linda C Giudice
- University of California San Francisco, San Francisco, CA, USA
| | | | | | - Christian M Becker
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Mauricio S Abrao
- BP-A Beneficência Portuguesa de São Paulo & Departamento de Ginecologia e Obstetrícia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | | - Krzysztof Wilk
- Boni Fratres Hospital Obstetrics & Gynecology Department Katowice, Katowice, Poland
| | - Yulan Li
- Myovant Sciences Inc., Brisbane, CA, USA
| | | | | | - Neil P Johnson
- Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
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Zutautas KB, Sisnett DJ, Miller JE, Lingegowda H, Childs T, Bougie O, Lessey BA, Tayade C. The dysregulation of leukemia inhibitory factor and its implications for endometriosis pathophysiology. Front Immunol 2023; 14:1089098. [PMID: 37033980 PMCID: PMC10076726 DOI: 10.3389/fimmu.2023.1089098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/08/2023] [Indexed: 04/11/2023] Open
Abstract
Endometriosis is an estrogen dominant, chronic inflammatory disease characterized by the growth of endometrial-like tissue outside of the uterus. The most common symptoms experienced by patients include manifestations of chronic pelvic pain- such as pain with urination, menstruation, or defecation, and infertility. Alterations to Leukemia Inhibitory Factor (LIF), a cytokine produced by the luminal and glandular epithelium of the endometrium that is imperative for successful pregnancy, have been postulated to contribute to infertility. Conditions such as recurrent implantation failure, unexplained infertility, and infertility associated diseases such as adenomyosis and endometriosis, have demonstrated reduced LIF production in the endometrium of infertile patients compared to fertile counterparts. While this highlights the potential involvement of LIF in infertility, LIF is a multifaceted cytokine which plays additional roles in the maintenance of cell stemness and immunomodulation. Thus, we sought to explore the implications of LIF production within ectopic lesions on endometriosis pathophysiology. Through immunohistochemistry of an endometrioma tissue microarray and ELISA of tissue protein extract and peritoneal fluid samples, we identify LIF protein expression in the ectopic lesion microenvironment. Targeted RT qPCR for LIF and associated signaling transcripts, identify LIF to be significantly downregulated in the ectopic tissue compared to eutopic and control while its receptor, LIFR, is upregulated, highlighting a discordance in ectopic protein and mRNA LIF expression. In vitro treatment of endometriosis representative cell lines (12Z and hESC) with LIF increased production of immune-recruiting cytokines (MCP-1, MCP-3) and the angiogenic factor, VEGF, as well as stimulated tube formation in human umbilical vein endothelial cells (HUVECs). Finally, LIF treatment in a syngeneic mouse model of endometriosis induced both local and peripheral alterations to immune cell phenotypes, ultimately reducing immunoregulatory CD206+ small peritoneal macrophages and T regulatory cells. These findings suggest that LIF is present in the ectopic lesions of endometriosis patients and could be contributing to lesion vascularization and immunomodulation.
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Affiliation(s)
- Katherine B. Zutautas
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON, Canada
| | - Danielle J. Sisnett
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON, Canada
| | - Jessica E. Miller
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON, Canada
| | | | - Timothy Childs
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON, Canada
- Department of Pathology and Molecular Medicine, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Olga Bougie
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON, Canada
- Department of Obstetrics and Gynaecology, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Bruce A. Lessey
- School of Medicine, Wake Forest University, Winston-Salem, NC, United States
| | - Chandrakant Tayade
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON, Canada
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McCallion A, Nasirzadeh Y, Lingegowda H, Miller JE, Khalaj K, Ahn S, Monsanto SP, Bidarimath M, Sisnett DJ, Craig AW, Young SL, Lessey BA, Koti M, Tayade C. Estrogen mediates inflammatory role of mast cells in endometriosis pathophysiology. Front Immunol 2022; 13:961599. [PMID: 36016927 PMCID: PMC9396281 DOI: 10.3389/fimmu.2022.961599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 07/15/2022] [Indexed: 11/13/2022] Open
Abstract
Endometriosis is an estrogen dependent, chronic inflammatory disease characterized by the growth of endometrial lining outside of the uterus. Mast cells have emerged as key players in regulating not only allergic responses but also other mechanisms such as angiogenesis, fibrosis, and pain. The influence of estrogen on mast cell function has also been recognized as a potential factor driving disease pathophysiology in number of allergic and chronic inflammatory conditions. However, precise information is lacking on the cross talk between endocrine and immune factors within the endometriotic lesions and whether that contributes to the involvement of mast cells with disease pathophysiology. In this study, we observed a significant increase in mast cell numbers within endometriotic lesions compared to matched eutopic endometrium from the same patients. Compared to eutopic endometrium, endometriotic lesions had significantly higher levels of stem cell factor (SCF), a potent growth factor critical for mast cell expansion, differentiation, and survival for tissue resident mast cells. Targeted mRNA Q-PCR array revealed that the endometriotic lesions harbour microenvironment (upregulation of CPA3, VCAM1, CCL2, CMA1, CCR1, and KITLG) that is conducive to mast cells recruitment and subsequent differentiation. To examine cross-talk of mast cells within the endometriotic lesion microenvironment, endometriotic epithelial cells (12Z) and endometrial stromal cells (hESC) incubated with mast cell-conditioned media showed significantly increased production of pro-inflammatory and chemokinetic cytokines. To further understand the impact of estrogen on mast cells in endometriosis, we induced endometriosis in C57BL/6 mice. Mature mast cells were significantly higher in peritoneal fluid of estrogen-treated mice compared to untreated mice within the sham operated groups. Mouse endometriotic lesion tissue revealed several genes (qRT-PCR) relevant in mast cell biology significantly upregulated in the estrogen treated, endometriosis-induced group compared to control endometrium. The endometriotic lesions from estrogen treated mice also had significantly higher density of Alcian blue stained mast cells compared to untreated lesions or control endometrium. Collectively, these findings suggest that endometriotic lesions provide a microenvironment necessary for recruitment and differentiation of mast cells. In turn, mast cells potentially release pro-inflammatory mediators that contribute to chronic pelvic pain and endometriosis disease progression.
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Affiliation(s)
- Alison McCallion
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON, Canada
| | - Yasmin Nasirzadeh
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON, Canada
| | | | - Jessica E. Miller
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON, Canada
| | - Kasra Khalaj
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON, Canada
| | - SooHyun Ahn
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON, Canada
| | - Stephany P. Monsanto
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON, Canada
| | - Mallikarjun Bidarimath
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON, Canada
| | - Danielle J. Sisnett
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON, Canada
| | - Andrew W. Craig
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, Canada
| | - Steven L. Young
- Department of Obstetrics and Gynecology, Wake Forest Baptist Health, Winston-Salem, NC, United States
| | - Bruce A. Lessey
- Department of Obstetrics and Gynecology, Wake Forest Baptist Health, Winston-Salem, NC, United States
| | - Madhuri Koti
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON, Canada
| | - Chandrakant Tayade
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON, Canada
- *Correspondence: Chandrakant Tayade,
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Giudice LC, As-Sanie S, Arjona Ferreira JC, Becker CM, Abrao MS, Lessey BA, Brown E, Dynowski K, Wilk K, Li Y, Mathur V, Warsi QA, Wagman RB, Johnson NP. Once daily oral relugolix combination therapy versus placebo in patients with endometriosis-associated pain: two replicate phase 3, randomised, double-blind, studies (SPIRIT 1 and 2). Lancet 2022; 399:2267-2279. [PMID: 35717987 DOI: 10.1016/s0140-6736(22)00622-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 03/13/2022] [Accepted: 03/28/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Endometriosis is a common cause of pelvic pain in women, for which current treatment options are suboptimal. Relugolix, an oral gonadotropin-releasing hormone receptor antagonist, combined with estradiol and a progestin, was evaluated for treatment of endometriosis-associated pain. METHODS In these two replicate, phase 3, multicentre, randomised, double-blind, placebo-controlled trials at 219 community and hospital research centres in Africa, Australasia, Europe, North America, and South America, we randomly assigned women aged 18-50 years with surgically or directly visualised endometriosis with or without histological confirmation, or with histological diagnosis alone. Participants were eligible if they had moderate to severe endometriosis-associated pain and, during the 35-day run-in period, a dysmenorrhoea Numerical Rating Scale (NRS) score of 4·0 or higher on two or more days and a mean non-menstrual pelvic pain NRS score of 2·5 or higher, or a mean score of 1·25 or higher that included a score of 5 or more on 4 or more days. Women received (1:1:1) once-daily oral placebo, relugolix combination therapy (relugolix 40 mg, estradiol 1 mg, norethisterone acetate 0·5 mg), or delayed relugolix combination therapy (relugolix 40 mg monotherapy followed by relugolix combination therapy, each for 12 weeks) for 24 weeks. During the double-blind randomised treatment and follow-up period, all patients, investigators, and sponsor staff or representatives involved in the conduct of the study were masked to treatment assignment. The co-primary endpoints were responder rates at week 24 for dysmenorrhoea and non-menstrual pelvic pain, both based on NRS scores and analgesic use. Efficacy and safety were analysed in the modified intent-to-treat population (randomised patients who received ≥1 study drug dose). The studies are registered at ClinicalTrials.gov (SPIRIT 1 [NCT03204318] and SPIRIT 2 [NCT03204331]) and EudraCT (SPIRIT 1 [2017-001588-19] and SPIRIT 2 [2017-001632-19]). Eligible patients who completed the SPIRIT studies could enrol in a currently ongoing 80-week open-label extension study (SPIRIT EXTENSION [NCT03654274, EudraCT 2017-004066-10]). Database lock for the on-treatment duration has occurred, and post-treatment follow-up for safety, specificially for bone mineral density and menses recovery, is ongoing at the time of publication. FINDINGS 638 patients were enrolled into SPIRIT 1 and randomly assigned between Dec 7, 2017, and Dec 4, 2019, to receive relugolix combination therapy (212 [33%]), placebo (213 [33%]), or relugolix delayed combination therapy (213 [33%]). 623 patients were enrolled into SPIRIT 2 and were randomly assigned between Nov 1, 2017 and Oct 4, 2019, to receive relugolix combination therapy (208 [33%]), placebo (208 [33%]), or relugolix delayed combination therapy (207 [33%]). 98 (15%) patients terminated study participation early in SPIRIT 1 and 115 (18%) in SPIRIT 2. In SPIRIT 1, 158 (75%) of 212 patients in the relugolix combination therapy group met the dysmenorrhoea responder criteria compared with 57 (27%) of 212 patients in the placebo group (treatment difference 47·6% [95% CI 39·3-56·0]; p<0·0001). In SPIRIT 2, 155 (75%) of 206 patients in the relugolix combination therapy group were dysmenorrhoea responders compared with 62 (30%) of 204 patients in the placebo group (treatment difference 44·9% [95% CI 36·2-53·5]; p<0·0001). In SPIRIT 1, 124 (58%) of 212 patients in the relugolix combination therapy group met the non-menstrual pelvic pain responder criteria versus 84 (40%) patients in the placebo group (treatment difference 18·9% [9·5-28·2]; p<0·0001). In SPIRIT 2, 136 (66%) of 206 patients were non-menstrual pelvic pain responders in the relugolix combination therapy group compared with 87 (43%) of 204 patients in the placebo group (treatment difference 23·4% [95% CI 13·9-32·8]; p<0·0001). The most common adverse events were headache, nasopharyngitis, and hot flushes. There were nine reports of suicidal ideation across both studies (two in the placebo run-in, two in the placebo group, two in the relugolix combination therapy group, and three in the delayed relugolix combination therapy group). No deaths were reported. Least squares mean percentage change in lumbar spine bone mineral density in the relugolix combination therapy versus placebo groups was -0·70% versus 0·21% in SPIRIT 1 and -0·78% versus 0·02% in SPIRIT 2, and in the delayed relugolix combination group was -2·0% in SPIRIT 1 and -1·9% in SPIRIT 2. Decreases in opioid use were seen in treated patients as compared with placebo. INTERPRETATION Once-daily relugolix combination therapy significantly improved endometriosis-associated pain and was well tolerated. This oral therapy has the potential to address the unmet clinical need for long-term medical treatment for endometriosis, reducing the need for opioid use or repeated surgical treatment. FUNDING Myovant Sciences.
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Affiliation(s)
- Linda C Giudice
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA.
| | - Sawsan As-Sanie
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | | | - Christian M Becker
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Mauricio S Abrao
- BP- A Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil; Departamento de Ginecologia e Obstetrícia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | | | - Eric Brown
- Gyn-Care in Atlantic Station, Atlanta, GA, USA
| | | | - Krzysztof Wilk
- Boni Fratres Hospital Obstetrics and Gynecology Department Katowice, Katowice, Poland
| | - Yulan Li
- Myovant Sciences, Brisbane, CA, USA
| | | | | | | | - Neil P Johnson
- Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
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Savaris RF, Lessey BA. B-cell lymphoma 6 (BCL6) testing before in vitro fertilization as a predictor of failure. Fertil Steril 2022; 118:419. [PMID: 35717285 DOI: 10.1016/j.fertnstert.2022.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/17/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Ricardo F Savaris
- Wake Forest University School of Medicine, Winston-Salem, North Carolina; Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Bruce A Lessey
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Hwang YJ, Sung GJ, Marquardt R, Young SL, Lessey BA, Kim TH, Cheon YP, Jeong JW. SIRT1 plays an important role in implantation and decidualization during mouse early pregnancy. Biol Reprod 2022; 106:1072-1082. [PMID: 35134122 PMCID: PMC9198957 DOI: 10.1093/biolre/ioac026] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 01/13/2022] [Accepted: 01/28/2022] [Indexed: 02/04/2023] Open
Abstract
Sirtuin 1 (SIRT1) is a member of the sirtuin family that functions to deacetylate both histones and non-histone proteins. Previous studies have identified significant SIRT1 upregulation in eutopic endometrium from infertile women with endometriosis. However, SIRT1 function in the uterus has not been directly studied. Using immunochemistry analysis, we found SIRT1 to be most strongly expressed at GD4.5 and GD5.5 in decidualized cells and at GD7.5 in secondary decidual cells in mouse. To assess the role of SIRT1 in uterine function, we generated uterine Sirt1 conditional knockout mice (Pgrcre/+Sirt1f/f; Sirt1d/d). A 6-month fertility trial revealed that Sirt1d/d females were subfertile. Implantation site numbers were significantly decreased in Sirt1d/d mice compared with controls at GD5.5. Sirt1d/d implantation sites at GD4.5 could be divided into two groups, Group #1 with luminal closure and nonspecific COX2 expression compared with controls (14/20) and Group #2 with an open lumen and no COX2 (6/20). In Sirt1d/d Group #1, nuclear FOXO1 expression in luminal epithelial cells was significantly decreased. In Sirt1d/d Group #2, nuclear FOXO1 expression was almost completely absent, and there was strong PGR expression in epithelial cells. At GD5.5, stromal PGR and COX2 were significantly decreased in Sirt1d/d uterine in the areas surrounding the embryo compared with controls, indicating defective decidualization. An artificially induced decidualization test revealed that Sirt1d/d females showed defects in decidualization response. All together, these data suggest that SIRT1 is important for decidualization and contributes to preparing a receptive endometrium for successful implantation.
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Affiliation(s)
- Yeon Jeong Hwang
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University, Grand Rapids, MI, USA
- Division of Developmental Biology and Physiology, Department of Biotechnology, Institute of Basic Sciences, Sungshin Women’s University, Seoul, South Korea
| | - Gi-Jun Sung
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University, Grand Rapids, MI, USA
| | - Ryan Marquardt
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University, Grand Rapids, MI, USA
- Cell and Molecular Biology Program, College of Natural Science, Michigan State University, East Lansing, MI, USA
| | - Steven L Young
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of North Carolina, Chapel Hill, NC, USA
| | - Bruce A Lessey
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertilithy, Atrium Health, Wake Forest Baptist, Winston-Salem, NC, USA
| | - Tae Hoon Kim
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University, Grand Rapids, MI, USA
| | - Yong-Pil Cheon
- Division of Developmental Biology and Physiology, Department of Biotechnology, Institute of Basic Sciences, Sungshin Women’s University, Seoul, South Korea
| | - Jae-Wook Jeong
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University, Grand Rapids, MI, USA
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Yoo JY, Kim TH, Shin JH, Marquardt RM, Müller U, Fazleabas AT, Young SL, Lessey BA, Yoon HG, Jeong JW. Loss of MIG-6 results in endometrial progesterone resistance via ERBB2. Nat Commun 2022; 13:1101. [PMID: 35232969 PMCID: PMC8888616 DOI: 10.1038/s41467-022-28608-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/27/2021] [Indexed: 01/17/2023] Open
Abstract
Female subfertility is highly associated with endometriosis. Endometrial progesterone resistance is suggested as a crucial element in the development of endometrial diseases. We report that MIG-6 is downregulated in the endometrium of infertile women with endometriosis and in a non-human primate model of endometriosis. We find ERBB2 overexpression in the endometrium of uterine-specific Mig-6 knockout mice (Pgrcre/+Mig-6f/f; Mig-6d/d). To investigate the effect of ERBB2 targeting on endometrial progesterone resistance, fertility, and endometriosis, we introduce Erbb2 ablation in Mig-6d/d mice (Mig-6d/dErbb2d/d mice). The additional knockout of Erbb2 rescues all phenotypes seen in Mig-6d/d mice. Transcriptomic analysis shows that genes differentially expressed in Mig-6d/d mice revert to their normal expression in Mig-6d/dErbb2d/d mice. Together, our results demonstrate that ERBB2 overexpression in endometrium with MIG-6 deficiency causes endometrial progesterone resistance and a nonreceptive endometrium in endometriosis-related infertility, and ERBB2 targeting reverses these effects. Female subfertility is highly associated with endometriosis. Here the authors show that progesterone-induced MIG-6 is reduced in endometrium of infertile women and non-human primates with endometriosis, and in a mouse model find that Erbb2 is the key mediator of Mig-6 loss induced endometriosis-related infertility.
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Affiliation(s)
- Jung-Yoon Yoo
- Department of Obstetrics,Gynecology & Reproductive Biology, Michigan State University, College of Human Medicine, Grand Rapids, MI, USA.,Department of Biomedical Laboratory Science, Yonsei University Mirae Campus, Wonju, South Korea
| | - Tae Hoon Kim
- Department of Obstetrics,Gynecology & Reproductive Biology, Michigan State University, College of Human Medicine, Grand Rapids, MI, USA
| | - Jung-Ho Shin
- Division of Reproductive Endocrinology, Department of Obstetrics & Gynecology, Guro Hospital, Korea University Medical Center, Seoul, South Korea
| | - Ryan M Marquardt
- Department of Obstetrics,Gynecology & Reproductive Biology, Michigan State University, College of Human Medicine, Grand Rapids, MI, USA.,Cell and Molecular Biology Program, Michigan State University, East Lansing, MI, USA
| | - Ulrich Müller
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Asgerally T Fazleabas
- Department of Obstetrics,Gynecology & Reproductive Biology, Michigan State University, College of Human Medicine, Grand Rapids, MI, USA
| | - Steven L Young
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - Bruce A Lessey
- Department of Obstetrics and Gynecology, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Ho-Geun Yoon
- Department of Biochemistry and Molecular Biology, Severance Medical Research Institute, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, South Korea.
| | - Jae-Wook Jeong
- Department of Obstetrics,Gynecology & Reproductive Biology, Michigan State University, College of Human Medicine, Grand Rapids, MI, USA.
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12
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Kim TH, Young SL, Sasaki T, Deaton JL, Schammel DP, Palomino WA, Jeong JW, Lessey BA. Role of SIRT1 and Progesterone Resistance in Normal and Abnormal Endometrium. J Clin Endocrinol Metab 2022; 107:788-800. [PMID: 34665857 PMCID: PMC8851922 DOI: 10.1210/clinem/dgab753] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Progesterone resistance, a known pathologic condition associated with a reduced cellular response to progesterone and heightened estrogen responses, appears to have a normal physiologic role in mammalian reproduction. The molecular mechanism responsible for progesterone resistance in normal and abnormal endometrium remains unclear. OBJECTIVE To examine the roles of sirtuin-1 (SIRT1) in normal endometrium as well as endometrium associated with infertility and endometriosis, as an epigenetic modulator associated with progesterone resistance. METHODS SIRT1 expression was examined by Western blot, quantitative real-time polymerase chain reaction, and immunohistochemistry in mouse uterus and human endometrium. Mice with uterine specific Sirt1 overexpression were developed to examine SIRT1's role in endometrial function and endometriosis development. EX-527, a SIRT1 inhibitor, and SRT1720, a SIRT1 agonist, were also used to evaluate SIRT1 effect on endometriosis. RESULTS In normal healthy women, endometrial SIRT1 is expressed only during menses. SIRT1 was dramatically overexpressed in the endometrium from women with endometriosis in both the epithelium and stroma. In mice, SIRT1 is expressed at the time of implantation between day 4.5 and 5.5 of pregnancy. Overexpression of SIRT1 in the mouse uterus leads to subfertility due to implantation failure, decidualization defects and progesterone resistance. SIRT1 overexpression in endometriotic lesions promotes worsening endometriosis development. EX-527 significantly reduced the number of endometriotic lesions in the mouse endometriosis model. CONCLUSIONS SIRT1 expression and progesterone resistance appears to play roles in normal endometrial functions. Aberrant SIRT1 expression contributes to progesterone resistance and may participate in the pathophysiology of endometriosis. SIRT1 is a novel and targetable protein for the diagnosis as well as treatment of endometriosis and the associated infertility seen in this disease.
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Affiliation(s)
- Tae Hoon Kim
- Department of Obstetrics, Gynecology & Reproductive Biology, Michigan State University, Grand Rapids, MI, USA
| | - Steven L Young
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - Tsutomu Sasaki
- Laboratory of Nutrition Chemistry, Division of Food Science and Biotechnology Graduate School of Agriculture, Kyoto University, Kitashirakawa Oiwakecho, Sakyo-ku, Kyoto, Kyoto, Japan
| | - Jeffrey L Deaton
- Department of Obstetrics and Gynecology, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | | | - Wilder Alberto Palomino
- Institute for Maternal and Child Research, Reproductive Medicine and Infertility Unit, University of Chile & Department of Obstetrics and Gynecology, San Borja Arriarán Clinical Hospital, Santiago, Chile
| | - Jae-Wook Jeong
- Department of Obstetrics, Gynecology & Reproductive Biology, Michigan State University, Grand Rapids, MI, USA
- Correspondence: Jae-Wook Jeong, PhD, Obstetrics, Gynecology & Reproductive Biology, Michigan State University, 400 Monroe Ave NW, Grand Rapids, MI, 49503, USA.
| | - Bruce A Lessey
- Department of Obstetrics and Gynecology, Wake Forest Baptist Health, Winston-Salem, NC, USA
- Bruce A. Lessey, MD, PhD, 1 Medical Center Blvd, 4th Floor Watlington Hall, Department of Obstetrics and Gynecology, Wake Forest Baptist Health, Winston-Salem, NC 27157, USA.
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13
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Miller JE, Lingegowda H, Symons LK, Bougie O, Young SL, Lessey BA, Koti M, Tayade C. IL-33 activates group 2 innate lymphoid cell expansion and modulates endometriosis. JCI Insight 2021; 6:149699. [PMID: 34699382 PMCID: PMC8675188 DOI: 10.1172/jci.insight.149699] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 10/22/2021] [Indexed: 01/01/2023] Open
Abstract
Chronic inflammation and localized alterations in immune cell function are suspected to contribute to the progression of endometriosis and its associated symptoms. In particular, the alarmin IL-33 is elevated in the plasma, peritoneal fluid, and endometriotic lesions from patients with endometriosis; however, the exact role of IL-33 in the pathophysiology of endometriosis is not well understood. In this study, we demonstrate, in both humans and a murine model, that IL-33 contributes to the expansion of group 2 innate lymphoid cells (ILC2s), and this IL-33–induced ILC2 expansion modulates the endometriosis lesion microenvironment. Importantly, we show that IL-33 drives hallmarks of severe endometriosis, including elevated inflammation, lesion proliferation, and fibrosis, and that this IL-33–induced aggravation is mediated by ILC2s. Finally, we demonstrate the functionality of IL-33 neutralization as a promising and potentially novel therapeutic avenue for treating the debilitating symptoms of endometriosis.
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Affiliation(s)
- Jessica E Miller
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | | | - Lindsey K Symons
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Olga Bougie
- Department of Obstetrics and Gynecology, Kingston General Hospital, Kingston, Ontario, Canada
| | - Steven L Young
- Department of Obstetrics and Gynecology University of North Carolina, Chapel Hill, North Carolina, USA
| | - Bruce A Lessey
- Department of Obstetrics and Gynecology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Madhuri Koti
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada.,Department of Obstetrics and Gynecology, Kingston General Hospital, Kingston, Ontario, Canada
| | - Chandrakant Tayade
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
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14
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Lingegowda H, Miller JE, McCallion A, Childs T, Lessey BA, Koti M, Tayade C. Implications of dysregulated endogenous cannabinoid family members in the pathophysiology of endometriosis. F S Sci 2021; 2:419-430. [PMID: 35559864 DOI: 10.1016/j.xfss.2021.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/21/2021] [Accepted: 09/29/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To determine the involvement of the endocannabinoid (EC) family member in the pathophysiology of endometriosis (EMS). DESIGN Mass spectrometry analysis of plasma and tissue samples from patients with EMS, controls, and a mouse model of EMS and messenger RNA and immunohistochemistry analysis of the samples from patients with EMS and controls. SETTING Academic teaching hospital and university. PATIENT(S) Patients with EMS and healthy fertile control subjects. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Endocannabinoid analysis in patient plasma, EMS lesions, and healthy endometrial samples. RESULT(S) Circulating ECs were detected in the plasma samples, whereas no significant changes were observed in patients with EMS compared with healthy fertile controls. However, the palmitoylethanolamide levels were significantly higher in the EMS lesions than in the endometrium from patients with EMS. Similarly, genes involved in the EC signaling pathways were differentially expressed in the EMS lesions. Analysis of cannabinoid 1 and 2 receptors in the EMS lesions revealed a significantly lower cannabinoid 2 receptor expression, whereas no significant changes were observed in cannabinoid 1 receptor expression compared with those in the endometrium from both patients with EMS and healthy fertile controls. The palmitoylethanolamide levels were significantly elevated in plasma from EMS mice compared with that from sham controls and in EMS lesions compared with uterine samples. CONCLUSION(S) Together, we provide evidence toward dysregulation of members of the ECs in both patients with EMS and the mouse model of EMS. These findings will advance the knowledge of the role of ECs in EMS and their potential implications as therapeutic targets.
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Affiliation(s)
| | - Jessica E Miller
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Alison McCallion
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Timothy Childs
- Department of Pathology and Molecular Medicine, Kingston Health Sciences Center, Kingston, Ontario, Canada
| | - Bruce A Lessey
- Department of Obstetrics and Gynecology, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Madhuri Koti
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada; Department of Obstetrics and Gynecology, Kingston Health Sciences Center, Kingston, Ontario, Canada; Division of Cancer Biology and Genetics, Queen's University, Kingston, Ontario, Canada
| | - Chandrakant Tayade
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada.
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15
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Sansone AM, Hisrich BV, Young RB, Abel WF, Bowens Z, Blair BB, Funkhouser AT, Schammel DP, Green LJ, Lessey BA, Blenda AV. Evaluation of BCL6 and SIRT1 as Non-Invasive Diagnostic Markers of Endometriosis. Curr Issues Mol Biol 2021; 43:1350-1360. [PMID: 34698105 PMCID: PMC8929102 DOI: 10.3390/cimb43030096] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 12/27/2022] Open
Abstract
(1) Background: Endometriosis is characterized by the presence of endometrial glands and stroma outside of the uterus and is often associated with severe pelvic pain and infertility. Our study explored the utilization of B-Cell Lymphoma 6 (BCL6) and Sirtuin 1 (SIRT1) as potential biomarkers in serum, plasma, urine, and cervical mucus for a non-invasive diagnostic test for endometriosis. BCL6 was chosen based on its previously reported elevated expression in endometrial biopsies, and SIRT1 is co-expressed and upregulated in the endometrium of women with endometriosis. (2) Methods: BCL6 and SIRT1 levels were measured using enzyme-linked immunoassay (ELISA) in samples from 20 women with endometriosis (ten with stages I/II and ten with stages III/IV) and ten women without endometriosis. (3) Results: Levels of SIRT1 in sera showed a statistically significant elevation in advanced stages III/IV compared to controls and stages I/II. No significant differences were found in other bodily fluids for SIRT1 or any bodily fluids tested for BCL6. (4) Conclusions: These results suggest some potential of SIRT1 expression within serum as a predictor of advanced asymptomatic stages of endometriosis. Using immunohistochemistry (IHC) staining and H-SCORE values for the elevated BCL6 (and potentially SIRT1) levels in endometrial biopsy samples seems to have higher diagnostic potential based on the previously published studies.
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Affiliation(s)
- Alison M. Sansone
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 607 Grove Rd., Greenville, SC 29605, USA; (A.M.S.); (B.V.H.); (R.B.Y.); (W.F.A.); (B.B.B.); (A.T.F.)
| | - Brooke V. Hisrich
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 607 Grove Rd., Greenville, SC 29605, USA; (A.M.S.); (B.V.H.); (R.B.Y.); (W.F.A.); (B.B.B.); (A.T.F.)
| | - R. Brandt Young
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 607 Grove Rd., Greenville, SC 29605, USA; (A.M.S.); (B.V.H.); (R.B.Y.); (W.F.A.); (B.B.B.); (A.T.F.)
| | - William F. Abel
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 607 Grove Rd., Greenville, SC 29605, USA; (A.M.S.); (B.V.H.); (R.B.Y.); (W.F.A.); (B.B.B.); (A.T.F.)
| | - Zachary Bowens
- Department of Obstetrics and Gynecology, Prisma Health Upstate, 701 Grove Rd., Greenville, SC 29605, USA; (Z.B.); (L.J.G.)
| | - Bailey B. Blair
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 607 Grove Rd., Greenville, SC 29605, USA; (A.M.S.); (B.V.H.); (R.B.Y.); (W.F.A.); (B.B.B.); (A.T.F.)
| | - Avery T. Funkhouser
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 607 Grove Rd., Greenville, SC 29605, USA; (A.M.S.); (B.V.H.); (R.B.Y.); (W.F.A.); (B.B.B.); (A.T.F.)
| | - David P. Schammel
- Pathology Associates of Greenville, 701 Grove Rd., Greenville, SC 29605, USA;
| | - Lisa J. Green
- Department of Obstetrics and Gynecology, Prisma Health Upstate, 701 Grove Rd., Greenville, SC 29605, USA; (Z.B.); (L.J.G.)
| | - Bruce A. Lessey
- Department of Obstetrics and Gynecology, Wake Forest University Baptist Hospital, 1 Medical Center Blvd, Winston-Salem, NC 27157, USA;
| | - Anna V. Blenda
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 607 Grove Rd., Greenville, SC 29605, USA; (A.M.S.); (B.V.H.); (R.B.Y.); (W.F.A.); (B.B.B.); (A.T.F.)
- Correspondence:
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16
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Adur MK, Braundmeier-Fleming AG, Lessey BA, Nowak RA. Altered eutopic endometrial T-regulatory and T-helper 17 lymphocyte ratio in women with unexplained subfertility. J Endometr Pelvic Pain Disord 2021; 13:185-194. [PMID: 34354965 PMCID: PMC8330881 DOI: 10.1177/22840265211018544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PROBLEM Perturbations in T-helper lymphocyte profiles have previously been associated with endometriosis related subfertility and conception failure. Hence a retrospective in vitro study was conducted to evaluate the relationship between T-regulatory (Treg) and T-helper 17 (Th17) lymphocytes in the eutopic endometrium of women with unexplained subfertility and correlate these profiles to their conception status. METHOD OF STUDY Eutopic endometrial biopsies were collected during the mid-secretory phase of the menstrual cycle, from women with unexplained subfertility. These samples were evaluated immunohistochemically for Treg and Th17 lymphocytes as well as the related proinflammatory cytokine, Interleukin-17 (IL-17). These eutopic endometrial T lymphocyte subpopulations were compared to the patients' conception status in subsequent cycles. RESULTS Though Treg cells were not indicative of conception success in subsequent cycles, patients who maintained their subfertile (no conception) status were observed to have a higher Th17 cell count in their eutopic endometrium. The ratio of Treg:Th17 cell counts was significantly correlated to patient conception status as well. These trends stayed consistent irrespective of concurrent endometriosis. CONCLUSION Patients with a high proinflammatory Th17 lymphocyte profile and low Treg:Th17 ratio in their eutopic endometrium during the secretory phase of their menstrual cycle are more likely to not conceive in subsequent cycles.
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Affiliation(s)
- Malavika K Adur
- Department of Animal Science, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Department of Animal Science, Iowa State University, Ames, IA, USA
| | - Andrea G Braundmeier-Fleming
- Department of Animal Science, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Department of Medical Microbiology, Immunology and Cell Biology, SIU School of Medicine, Springfield, IL, USA
- Department of Obstetrics and Gynecology, SIU School of Medicine, Springfield, IL, USA
| | - Bruce A Lessey
- Department of Obstetrics and Gynecology, Greenville Hospital System, Greenville, SC, USA
- Department of Obstetrics and Gynecology, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Romana A Nowak
- Department of Animal Science, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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17
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Paule SG, Heng S, Samarajeewa N, Li Y, Mansilla M, Webb AI, Nebl T, Young SL, Lessey BA, Hull ML, Scelwyn M, Lim R, Vollenhoven B, Rombauts LJ, Nie G. Podocalyxin is a key negative regulator of human endometrial epithelial receptivity for embryo implantation. Hum Reprod 2021; 36:1353-1366. [PMID: 33822049 DOI: 10.1093/humrep/deab032] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 12/09/2020] [Indexed: 02/02/2023] Open
Abstract
STUDY QUESTION How is endometrial epithelial receptivity, particularly adhesiveness, regulated at the luminal epithelial surface for embryo implantation in the human? SUMMARY ANSWER Podocalyxin (PCX), a transmembrane protein, was identified as a key negative regulator of endometrial epithelial receptivity; specific downregulation of PCX in the luminal epithelium in the mid-secretory phase, likely mediated by progesterone, may act as a critical step in converting endometrial surface from a non-receptive to an implantation-permitting state. WHAT IS KNOWN ALREADY The human endometrium must undergo major molecular and cellular changes to transform from a non-receptive to a receptive state to accommodate embryo implantation. However, the fundamental mechanisms governing receptivity, particularly at the luminal surface where the embryo first interacts with, are not well understood. A widely held view is that upregulation of adhesion-promoting molecules is important, but the details are not well characterized. STUDY DESIGN, SIZE, DURATION This study first aimed to identify novel adhesion-related membrane proteins with potential roles in receptivity in primary human endometrial epithelial cells (HEECs). Further experiments were then conducted to determine candidates' in vivo expression pattern in the human endometrium across the menstrual cycle, regulation by progesterone using cell culture, and functional importance in receptivity using in vitro human embryo attachment and invasion models. PARTICIPANTS/MATERIALS, SETTING, METHODS Primary HEECs (n = 9) were isolated from the proliferative phase endometrial tissue, combined into three pools, subjected to plasma membrane protein enrichment by ultracentrifugation followed by proteomics analysis, which led to the discovery of PCX as a novel candidate of interest. Immunohistochemical analysis determined the in vivo expression pattern and cellular localization of PCX in the human endometrium across the menstrual cycle (n = 23). To investigate whether PCX is regulated by progesterone, the master driver of endometrial differentiation, primary HEECs were treated in culture with estradiol and progesterone and analyzed by RT-PCR (n = 5) and western blot (n = 4). To demonstrate that PCX acts as a negative regulator of receptivity, PCX was overexpressed in Ishikawa cells (a receptive line) and the impact on receptivity was determined using in vitro attachment (n = 3-5) and invasion models (n = 4-6), in which an Ishikawa monolayer mimicked the endometrial surface and primary human trophoblast spheroids mimicked embryos. Mann-Whitney U-test and ANOVA analyses established statistical significance at *P ≤ 0.05 and **P ≤ 0.01. MAIN RESULTS AND THE ROLE OF CHANCE PCX was expressed on the apical surface of all epithelial and endothelial cells in the non-receptive endometrium, but selectively downregulated in the luminal epithelium from the mid-secretory phase coinciding with the establishment of receptivity. Progesterone was confirmed to be able to suppress PCX in primary HEECs, suggesting this hormone likely mediates the downregulation of luminal PCX in vivo for receptivity. Overexpression of PCX in Ishikawa monolayer inhibited not only the attachment but also the penetration of human embryo surrogates, demonstrating that PCX acts as an important negative regulator of epithelial receptivity for implantation. LIMITATIONS, REASONS FOR CAUTION Primary HEECs isolated from the human endometrial tissue contained a mixture of luminal and glandular epithelial cells, as further purification into subtypes was not possible due to the lack of specific markers. Future study would need to investigate how progesterone differentially regulates PCX in endometrial epithelial subtypes. In addition, this study used primary human trophoblast spheroids as human embryo mimics and Ishikawa as endometrial epithelial cells in functional models, future studies with human blastocysts and primary epithelial cells would further validate the findings. WIDER IMPLICATIONS OF THE FINDINGS The findings of this study add important new knowledge to the understanding of human endometrial remodeling for receptivity. The identification of PCX as a negative regulator of epithelial receptivity and the knowledge that its specific downregulation in the luminal epithelium coincides with receptivity development may provide new avenues to assess endometrial receptivity and individualize endometrial preparation protocols in assisted reproductive technology (ART). The study also discovered PCX as progesterone target in HEECs, identifying a potentially useful functional biomarker to monitor progesterone action, such as in the optimization of progesterone type/dose/route of administration for luteal support. STUDY FUNDING/COMPETING INTEREST(S) Study funding was obtained from ESHRE, Monash IVF and NHMRC. LR reports potential conflict of interests (received grants from Ferring Australia; personal fees from Monash IVF Group and Ferring Australia; and non-financial support from Merck Serono, MSD, and Guerbet outside the submitted work. LR is also a minority shareholder and the Group Medical Director for Monash IVF Group, a provider of fertility preservation services). The remaining authors have no potential conflict of interest to declare. TRIAL REGISTRATION NUMBER NA.
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Affiliation(s)
- Sarah G Paule
- Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, VIC, Australia
| | - Sophea Heng
- Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, VIC, Australia.,Implantation and Pregnancy Research Laboratory, School of Health and Biomedical Sciences, RMIT University, VIC, Australia
| | - Nirukshi Samarajeewa
- Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, VIC, Australia.,Implantation and Pregnancy Research Laboratory, School of Health and Biomedical Sciences, RMIT University, VIC, Australia
| | - Ying Li
- Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, VIC, Australia.,Implantation and Pregnancy Research Laboratory, School of Health and Biomedical Sciences, RMIT University, VIC, Australia
| | - Mary Mansilla
- Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, VIC, Australia.,Implantation and Pregnancy Research Laboratory, School of Health and Biomedical Sciences, RMIT University, VIC, Australia
| | - Andrew I Webb
- Advance Technology and Biology Division, The Walter and Eliza Hall Institute, Parkville, VIC, Australia
| | - Thomas Nebl
- Advance Technology and Biology Division, The Walter and Eliza Hall Institute, Parkville, VIC, Australia
| | - Steven L Young
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - Bruce A Lessey
- Department of Obstetrics and Gynecology, Greenville Health System, Greenville, SC, USA
| | - M Louise Hull
- The Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | | | - Rebecca Lim
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - Beverley Vollenhoven
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia.,Womens and Newborn Programme, Monash Health, Clayton, VIC, Australia
| | - Luk J Rombauts
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia.,Womens and Newborn Programme, Monash Health, Clayton, VIC, Australia
| | - Guiying Nie
- Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, VIC, Australia.,Implantation and Pregnancy Research Laboratory, School of Health and Biomedical Sciences, RMIT University, VIC, Australia
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18
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Miller JE, Lingegowda H, Symons LK, Bougie O, Young SL, Lessey BA, Koti M, Tayade C. IL-33 activates ILC2 expansion and modulates endometriosis. The Journal of Immunology 2021. [DOI: 10.4049/jimmunol.206.supp.12.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Abstract
Introduction: Chronic inflammation drives endometriosis (EM) and its associated symptoms. Interleukin (IL)-33, has gained therapeutic interest as it is elevated in the plasma, peritoneal fluid (PF), and lesions of EM patients. However, how IL-33 contributes to EM is largely unknown. For the first time, we demonstrate, using both human samples and murine models, that IL-33 expands local group 2 innate lymphoid cells (ILC2s) and that IL-33 activated ILC2s modulate hallmark features of EM.
Methods:
We identified ILC2s (CD45+Lin−CRTH2+CD127+ST2+) in the PF of EM patients using flow cytometry. Using immunofluorescence, we determine whether IL-33 forms epithelial or stromal cell niches within the EM lesion. Then, using our well established EM model, we induced EM in female C57Bl/6 mice and treated with PBS or IL-33. Hallmark features of EM were assessed including inflammation (using multiplex cytokine analysis), immune cell profiling (using flow cytometry), and lesion architecture (using immunohistochemistry and Nanostring transcriptomic profiling). To establish cause and effect, we treated ILC2 deficient mice with PBS (n=5) or IL-33 (n=5). Unpaired t-tests and one-way ANOVAs were done when appropriate.
Results/Discussion:
In humans, ILC2s are present and elevated in EM patients (n=5) compared to healthy donors (n=3) and IL-33 colocalized with both epithelial and stromal cells within the EM lesion. Using murine models, IL-33 drove hallmark features of EM including increased inflammation, alterations in PF immune cells (including eosinophils, T cells, macrophages and ILC2s), as well as increased lesion proliferation, neurogenesis and fibrosis. Using ILC2 deficient mice, we show that IL-33 induced pathology is ILC2 dependent.
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Affiliation(s)
| | | | | | | | - Steven L Young
- 3University of North Carolina, School of Medicine, Chapel Hill
| | | | - Madhuri Koti
- 5Cancer Research Institute, Queen's University, Canada
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19
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Kim HI, Kim TH, Yoo JY, Young SL, Lessey BA, Ku BJ, Jeong JW. ARID1A and PGR proteins interact in the endometrium and reveal a positive correlation in endometriosis. Biochem Biophys Res Commun 2021; 550:151-157. [PMID: 33706098 DOI: 10.1016/j.bbrc.2021.02.144] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 02/28/2021] [Indexed: 11/16/2022]
Abstract
Endometriosis is a disorder in which endometrial cells normally limited to the lining of the uterus proliferate outside the uterine cavity and can cause pelvic pain and infertility. ARID1A levels are significantly reduced in the eutopic endometrium from women with endometriosis. Uterine specific Arid1a knock-out mice were infertile due to loss of epithelial progesterone receptor (PGR) signaling. However, the functional association of ARID1A and PGR in endometriosis has not been studied. We examined the expression patterns and co-localization of ARID1A and PGR in eutopic endometrium from women with and without endometriosis using immunostaining and Western blot analysis. ARID1A and PGR proteins co-localized in the epithelium during the proliferative and the early secretory phases. Our immunoprecipitation analysis and proximity ligation assay (PLA) revealed physical interaction between ARID1A and PGR-A but not PGR-B in the mouse and human endometrium. ARID1A levels positively correlated with PGR levels in the eutopic endometrium of women with endometriosis. Our results bring new perspectives on the molecular mechanisms involved in endometrial receptivity and progesterone resistance in endometriosis. The interrelationship between ARID1A and PGR may contribute to explaining the non-receptive endometrium in endometriosis-related infertility.
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Affiliation(s)
- Hong Im Kim
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University, Grand Rapids, MI, 49503, USA
| | - Tae Hoon Kim
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University, Grand Rapids, MI, 49503, USA
| | - Jung-Yoon Yoo
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University, Grand Rapids, MI, 49503, USA; Life Science Institute, Repure Life Science, Seoul, 03722, Republic of Korea
| | - Steven L Young
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, 27514, USA
| | - Bruce A Lessey
- Department of Obstetrics and Gynecology, Wake Forest Baptist Health, Winston-Salem, NC, 27157, USA
| | - Bon Jeong Ku
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, 35015, Republic of Korea.
| | - Jae-Wook Jeong
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University, Grand Rapids, MI, 49503, USA.
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20
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Joshi NR, Kohan-Ghadr HR, Roqueiro DS, Yoo JY, Fru K, Hestermann E, Yuan L, Ho SM, Jeong JW, Young SL, Lessey BA, Fazleabas AT. Genetic and epigenetic changes in the eutopic endometrium of women with endometriosis: association with decreased endometrial αvβ3 integrin expression. Mol Hum Reprod 2021; 27:6163298. [PMID: 33693877 DOI: 10.1093/molehr/gaab018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 02/09/2021] [Indexed: 01/10/2023] Open
Abstract
About 40% of women with infertility and 70% of women with pelvic pain suffer from endometriosis. The pregnancy rate in women undergoing IVF with low endometrial integrin αvβ3 (LEI) expression is significantly lower compared to the women with high endometrial integrin αvβ3 (HEI). Mid-secretory eutopic endometrial biopsies were obtained from healthy controls (C; n=3), and women with HEI (n=4) and LEI (n=4) and endometriosis. Changes in gene expression were assessed using human gene arrays and DNA methylation data were derived using 385 K Two-Array Promoter Arrays. Transcriptional analysis revealed that LEI and C groups clustered separately with 396 differentially expressed genes (DEGs) (P<0.01: 275 up and 121 down) demonstrating that transcriptional and epigenetic changes are distinct in the LEI eutopic endometrium compared to the C and HEI group. In contrast, HEI vs C and HEI vs LEI comparisons only identified 83 and 45 DEGs, respectively. The methylation promoter array identified 1304 differentially methylated regions in the LEI vs C comparison. The overlap of gene and methylation array data identified 14 epigenetically dysregulated genes and quantitative RT-PCR analysis validated the transcriptomic findings. The analysis also revealed that aryl hydrocarbon receptor (AHR) was hypomethylated and significantly overexpressed in LEI samples compared to C. Further analysis validated that AHR transcript and protein expression are significantly (P<0.05) increased in LEI women compared to C. The increase in AHR, together with the altered methylation status of the 14 additional genes, may provide a diagnostic tool to identify the subset of women who have endometriosis-associated infertility.
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Affiliation(s)
- Niraj R Joshi
- Michigan State University, College of Human Medicine, Grand Rapids, MI, USA
| | | | | | - Jung Yoon Yoo
- Department of Biochemistry and Molecular Biology, Brain Korea 21 Project for Medical Sciences, Yonsei University College of Medicine, Seoul, South Korea
| | - Karenne Fru
- Coastal Reproductive Endocrinology and Infertility, Wilmington, NC, USA
| | | | - Lingwen Yuan
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Shuk-Mei Ho
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jae-Wook Jeong
- Michigan State University, College of Human Medicine, Grand Rapids, MI, USA
| | - Steven L Young
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
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21
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Marquardt RM, Kim TH, Yoo JY, Teasley HE, Fazleabas AT, Young SL, Lessey BA, Arora R, Jeong JW. Endometrial epithelial ARID1A is critical for uterine gland function in early pregnancy establishment. FASEB J 2021; 35:e21209. [PMID: 33222288 PMCID: PMC8076973 DOI: 10.1096/fj.202002178r] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/26/2020] [Accepted: 11/04/2020] [Indexed: 12/23/2022]
Abstract
Though endometriosis and infertility are clearly associated, the pathophysiological mechanism remains unclear. Previous work has linked endometrial ARID1A loss to endometriosis-related endometrial non-receptivity. Here, we show in mice that ARID1A binds and regulates transcription of the Foxa2 gene required for endometrial gland function. Uterine-specific deletion of Arid1a compromises gland development and diminishes Foxa2 and Lif expression. Deletion of Arid1a with Ltf-iCre in the adult mouse endometrial epithelium preserves the gland development while still compromising the gland function. Mice lacking endometrial epithelial Arid1a are severely sub-fertile due to defects in implantation, decidualization, and endometrial receptivity from disruption of the LIF-STAT3-EGR1 pathway. FOXA2 is also reduced in the endometrium of women with endometriosis in correlation with diminished ARID1A, and both ARID1A and FOXA2 are reduced in nonhuman primates induced with endometriosis. Our findings describe a role for ARID1A in the endometrial epithelium supporting early pregnancy establishment through the maintenance of gland function.
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Affiliation(s)
- Ryan M. Marquardt
- Department of Obstetrics, Gynecology & Reproductive Biology, Michigan State University, Grand Rapids, MI, USA
- Cell and Molecular Biology Program, Michigan State University, East Lansing, MI, USA
| | - Tae Hoon Kim
- Department of Obstetrics, Gynecology & Reproductive Biology, Michigan State University, Grand Rapids, MI, USA
| | - Jung-Yoon Yoo
- Department of Biochemistry and Molecular Biology, Brain Korea 21 PLUS Project for Medical Sciences, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hanna E. Teasley
- Department of Obstetrics, Gynecology & Reproductive Biology, Michigan State University, Grand Rapids, MI, USA
| | - Asgerally T. Fazleabas
- Department of Obstetrics, Gynecology & Reproductive Biology, Michigan State University, Grand Rapids, MI, USA
| | - Steven L. Young
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - Bruce A. Lessey
- Department of Obstetrics and Gynecology, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Ripla Arora
- Department of Obstetrics, Gynecology & Reproductive Biology, Michigan State University, Grand Rapids, MI, USA
- Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI, USA
| | - Jae-Wook Jeong
- Department of Obstetrics, Gynecology & Reproductive Biology, Michigan State University, Grand Rapids, MI, USA
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22
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Wilson MR, Reske JJ, Holladay J, Neupane S, Ngo J, Cuthrell N, Wegener M, Rhodes M, Adams M, Sheridan R, Hostetter G, Alotaibi FT, Yong PJ, Anglesio MS, Lessey BA, Leach RE, Teixeira JM, Missmer SA, Fazleabas AT, Chandler RL. ARID1A Mutations Promote P300-Dependent Endometrial Invasion through Super-Enhancer Hyperacetylation. Cell Rep 2020; 33:108366. [PMID: 33176148 PMCID: PMC7682620 DOI: 10.1016/j.celrep.2020.108366] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 09/16/2020] [Accepted: 10/16/2020] [Indexed: 12/12/2022] Open
Abstract
Endometriosis affects 1 in 10 women and is characterized by the presence of abnormal endometrium at ectopic sites. ARID1A mutations are observed in deeply invasive forms of the disease, often correlating with malignancy. To identify epigenetic dependencies driving invasion, we use an unbiased approach to map chromatin state transitions accompanying ARID1A loss in the endometrium. We show that super-enhancers marked by high H3K27 acetylation are strongly associated with ARID1A binding. ARID1A loss leads to H3K27 hyperacetylation and increased chromatin accessibility and enhancer RNA transcription at super-enhancers, but not typical enhancers, indicating that ARID1A normally prevents super-enhancer hyperactivation. ARID1A co-localizes with P300 at super-enhancers, and genetic or pharmacological inhibition of P300 in ARID1A mutant endometrial epithelia suppresses invasion and induces anoikis through the rescue of super-enhancer hyperacetylation. Among hyperactivated super-enhancers, SERPINE1 (PAI-1) is identified as an essential target gene driving ARID1A mutant endometrial invasion. Broadly, our findings provide rationale for therapeutic strategies targeting super-enhancers in ARID1A mutant endometrium.
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Affiliation(s)
- Mike R Wilson
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA
| | - Jake J Reske
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA
| | - Jeanne Holladay
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA
| | - Subechhya Neupane
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA
| | - Julie Ngo
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA
| | - Nina Cuthrell
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA
| | - Marc Wegener
- Genomics Core Facility, Van Andel Research Institute, Grand Rapids, MI 49503, USA
| | - Mary Rhodes
- Genomics Core Facility, Van Andel Research Institute, Grand Rapids, MI 49503, USA
| | - Marie Adams
- Genomics Core Facility, Van Andel Research Institute, Grand Rapids, MI 49503, USA
| | - Rachael Sheridan
- Flow Cytometry Core, Van Andel Research Institute, Grand Rapids, MI 49503, USA
| | - Galen Hostetter
- Pathology and Biorepository Core, Van Andel Research Institute, Grand Rapids, MI 49503, USA
| | - Fahad T Alotaibi
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada; Department of Physiology, College of Medicine, Al-Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Paul J Yong
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Michael S Anglesio
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada; British Columbia's Gynecological Cancer Research Team (OVCARE), University of British Columbia, Vancouver General Hospital, and BC Cancer, Vancouver, BC, Canada
| | - Bruce A Lessey
- Department of Obstetrics and Gynecology, Wake Forest Baptist Health, Winston-Salem, NC 27157, USA
| | - Richard E Leach
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA; Department of Women's Health, Spectrum Health System, Grand Rapids, MI 49341, USA
| | - Jose M Teixeira
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA; Department of Women's Health, Spectrum Health System, Grand Rapids, MI 49341, USA
| | - Stacey A Missmer
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA; Department of Women's Health, Spectrum Health System, Grand Rapids, MI 49341, USA
| | - Asgerally T Fazleabas
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA; Department of Women's Health, Spectrum Health System, Grand Rapids, MI 49341, USA
| | - Ronald L Chandler
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA; Department of Women's Health, Spectrum Health System, Grand Rapids, MI 49341, USA; Center for Epigenetics, Van Andel Research Institute, Grand Rapids, MI 49503, USA.
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23
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Abstract
Pain associated with endometriosis is a considerable burden for women, permeating all aspects of their lives, from their ability to perform daily activities to their quality of life. Although there are many options for endometriosis-associated pain management, they are often limited by insufficient efficacy, inconvenient routes of administration, and/or intolerable side effects. Elagolix, a nonpeptide, small-molecule gonadotropin-releasing hormone (GnRH) receptor antagonist, is the first new oral therapy to be approved for the treatment of endometriosis-associated pain in the United States in more than a decade. Modulation of estradiol with elagolix is dose dependent and ranges from partial to full suppression. Clinical evidence has shown that elagolix at both approved doses (150 mg once daily and 200 mg twice daily) is effective for reducing symptoms of pelvic pain (dysmenorrhea, nonmenstrual pelvic pain, and dyspareunia), improving quality of life, and decreasing use of rescue analgesics (nonsteroidal anti-inflammatory drugs and/or opioids). The availability of two dosing options allows for individualization of treatment based on baseline clinical factors and response to therapy. Elagolix is well tolerated, with less pronounced hypoestrogenic effects compared with GnRH agonists. This review provides an overview of elagolix, highlighting currently available treatment options and the application of this new treatment for women with endometriosis-associated pain.
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Affiliation(s)
- Nicholas Leyland
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Stephanie J Estes
- Department of Obstetrics and Gynecology, Penn State Health, Hershey, Pennsylvania, USA
| | - Bruce A Lessey
- Wake Forest Health, Center for Fertility, Endocrine and Menopause, Winston-Salem, North Carolina, USA
| | - Arnold P Advincula
- Department of Obstetrics and Gynecology, Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York, USA
| | - Hugh S Taylor
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
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Lessey BA, Young SL, Kim TH, Jeong JW. SIRT1 AND PROGESTERONE (P4) RESISTANCE AND ENDOMETRIOSIS: IMPLICATIONS FOR INFERTILITY MANAGEMENT. Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.08.573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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25
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Affiliation(s)
- Bruce A Lessey
- Department of Obstetrics and Gynecology, Wake Forest Baptist Health, Winston-Salem, North Carolina
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26
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Overholt TL, Evans RJ, Lessey BA, Matthews CA, Hines KN, Badlani G, Walker SJ. Non-bladder centric interstitial cystitis/bladder pain syndrome phenotype is significantly associated with co-occurring endometriosis. Can J Urol 2020; 27:10257-10262. [PMID: 32544050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Interstitial cystitis/bladder pain syndrome (IC/BPS) and endometriosis are coexistent diagnoses in 48%-65% of women with chronic pelvic pain (CPP), suggesting that dual screening may be warranted. To further investigate the clinical relationship and risk factors between these two conditions, we performed a retrospective review of our large IC/BPS patient data registry. MATERIALS AND METHODS We evaluated IC/BPS patients who were prospectively enrolled into our registry who completed validated questionnaires and underwent therapeutic hydrodistension, during which anesthetic bladder capacity (BC) and Hunner's lesion (HL) status were recorded. Demographic/medical history were reviewed. IC/BPS patients with co-occurring endometriosis diagnosis versus those without were compared using descriptive statistics as well as multivariate regression analyses to determine predictors of co-occurring disease. RESULTS Of 431 IC/BPS participants, 82 (19%) were also diagnosed with endometriosis. These women were significantly younger, had increased prevalence of non-low BC (> 400 cc), and decreased prevalence of HL (p < 0.05). Patients with co-occurring endometriosis also had increased prevalence of irritable bowel syndrome (IBS), CPP, fibromyalgia, and vulvodynia (p < 0.05). On multivariate analysis, non-low BC (OR 4.53, CI 1.004-20.42, p = 0.049), CPP (OR 1.84, CI 1.04-3.24, p = 0.04), and fibromyalgia (OR 1.80, CI 1.03-3.14, p < 0.04) were significantly associated with a diagnosis of endometriosis. CONCLUSIONS Patients with IC/BPS and co-occurring endometriosis were significantly more likely to carry a non-bladder centric IC/BPS phenotype as well as several comorbid, systemic pain diagnoses. This study characterizes features of a target IC/BPS phenotype that could potentially benefit from endometriosis and systemic pain syndrome screening.
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Affiliation(s)
- Tyler L Overholt
- Department of Urology/Pelvic Health, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
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27
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Song Y, Su RW, Joshi NR, Kim TH, Lessey BA, Jeong JW, Fazleabas AT. Interleukin-6 (IL-6) Activates the NOTCH1 Signaling Pathway Through E-Proteins in Endometriotic Lesions. J Clin Endocrinol Metab 2020; 105:5771387. [PMID: 32119078 PMCID: PMC7096313 DOI: 10.1210/clinem/dgaa096] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 02/26/2020] [Indexed: 01/28/2023]
Abstract
CONTEXT NOTCH signaling is activated in endometriotic lesions, but the exact mechanisms remains unclear. IL-6, which is increased in the peritoneal fluid of women with endometriosis, induces NOTCH1 through E-proteins including E2A and HEB in cancer. OBJECTIVE To study the role of E-proteins in inducing NOTCH1 expression under the regulation of IL-6 in endometriosis. SETTING AND DESIGN The expression of E-proteins and NOTCH1 was first investigated in endometrium of women with endometriosis and the baboon model of endometriosis. Regulation of E-proteins and NOTCH1 expression was examined after IL-6 stimulation and siRNA mediated inhibition of E2A or/and HEB in human endometriotic epithelial cells (12Z) in vitro, and subsequently following IL-6 treatment in the mouse model of endometriosis in vivo. RESULTS E2A, HEB, and NOTCH1 were significantly upregulated in glandular epithelium (GE) of ectopic endometrium compared to eutopic endometrium in both women and the baboon model. IL-6 treatment upregulated the expression of NOTCH1 together with E2A and HEB in 12Z cells. Small interfering RNA inhibition of E2A and HEB or HEB alone decreased NOTCH1 expression. Binding efficiency of both E2A and HEB was significantly higher at the binding sites on the human NOTCH1 promoter after IL-6 treatment. Finally, IL-6 treatment resulted in a significantly increased number of endometriotic lesions along with increased expression of E2A, HEB, and NOTCH1 in GE of the lesions compared with the vehicle group in an endometriosis mouse model. CONCLUSIONS IL-6 induced NOTCH1 expression is mediated by E-proteins in the ectopic GE cells, which may promote endometriotic lesion development.
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Affiliation(s)
- Yong Song
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University, Grand Rapids, Michigan, USA
| | - Ren-Wei Su
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
| | - Niraj R Joshi
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University, Grand Rapids, Michigan, USA
| | - Tae Hoon Kim
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University, Grand Rapids, Michigan, USA
| | - Bruce A Lessey
- Center for Fertility, Endocrinology and Menopause, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Jae-Wook Jeong
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University, Grand Rapids, Michigan, USA
| | - Asgerally T Fazleabas
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University, Grand Rapids, Michigan, USA
- Correspondence and Reprint Requests: Asgerally T. Fazleabas, PhD, Department of Obstetrics and Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503. E-mail:
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28
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Kim TH, Yoo JY, Choi KC, Shin JH, Leach RE, Fazleabas AT, Young SL, Lessey BA, Yoon HG, Jeong JW. Loss of HDAC3 results in nonreceptive endometrium and female infertility. Sci Transl Med 2020; 11:11/474/eaaf7533. [PMID: 30626716 DOI: 10.1126/scitranslmed.aaf7533] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 11/16/2018] [Indexed: 12/13/2022]
Abstract
Endometriosis is a disease in which tissue that normally grows inside the uterus grows outside the uterus and causes chronic pelvic pain and infertility. However, the exact mechanisms of the pathogenesis of endometriosis-associated infertility are unknown. Epigenetic dysregulation has recently been implicated in infertility. Here, we report a reduction of histone deacetylase 3 (HDAC3) protein amounts in eutopic endometrium of infertile women with endometriosis compared to a control group. To investigate the effect of HDAC3 loss in the uterus, we generated mice with conditional ablation of Hdac3 in progesterone receptor (PGR)-positive cells (Pgrcre/+Hdac3f/f ; Hdac3d/d ). Loss of Hdac3 in the uterus of mice results in infertility due to implantation failure and decidualization defect. Expression microarray and ChIP-seq analyses identified COL1A1 and COL1A2 as direct targets of HDAC3 in both mice and humans. Reduction of HDAC3 abrogated decidualization in a primary culture of human endometrial stromal cells (hESCs) similar to that observed in infertile patients with endometriosis. Whereas attenuation of HDAC3 resulted in p300 recruitment to Col1a1 and Col1a2 genes in the uterus of mice as well as hESCs, inhibition of p300 permitted hESCs to undergo decidualization. Collectively, we found attenuation of HDAC3 and overexpression of collagen type I in the eutopic endometrium of infertile patients with endometriosis. HDAC3 loss caused a defect of decidualization through the aberrant transcriptional activation of Col1a1 and Col1a2 genes in mice and COL1A1 and COL1A2 genes in humans. Our results suggest that HDAC3 is critical for endometrial receptivity and decidualization.
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Affiliation(s)
- Tae Hoon Kim
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University, Grand Rapids, MI 49534, USA
| | - Jung-Yoon Yoo
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University, Grand Rapids, MI 49534, USA.,Department of Biochemistry and Molecular Biology, Brain Korea 21 PLUS Project for Medical Sciences, Yonsei University College of Medicine, Seoul 03722, South Korea
| | - Kyung-Chul Choi
- Department of Biomedical Sciences, University of Ulsan College of Medicine, Seoul 05505, South Korea.,Department of Pharmacology, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Jung-Ho Shin
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Guro Hospital, Korea University Medical Center, Seoul 08318, South Korea
| | - Richard E Leach
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University, Grand Rapids, MI 49534, USA.,Department of Women's Health, Spectrum Health System, Grand Rapids, MI 49341, USA
| | - Asgerally T Fazleabas
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University, Grand Rapids, MI 49534, USA.,Department of Women's Health, Spectrum Health System, Grand Rapids, MI 49341, USA
| | - Steven L Young
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Bruce A Lessey
- Obstetrics and Gynecology, Greenville Health System, Greenville, SC 29605, USA
| | - Ho-Geun Yoon
- Department of Biochemistry and Molecular Biology, Brain Korea 21 PLUS Project for Medical Sciences, Yonsei University College of Medicine, Seoul 03722, South Korea.
| | - Jae-Wook Jeong
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University, Grand Rapids, MI 49534, USA. .,Department of Women's Health, Spectrum Health System, Grand Rapids, MI 49341, USA
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Hisrich BV, Young RB, Sansone AM, Bowens Z, Green LJ, Lessey BA, Blenda AV. Role of Human Galectins in Inflammation and Cancers Associated with Endometriosis. Biomolecules 2020; 10:biom10020230. [PMID: 32033052 PMCID: PMC7072718 DOI: 10.3390/biom10020230] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 01/31/2020] [Accepted: 02/02/2020] [Indexed: 12/11/2022] Open
Abstract
Galectins are a family of β-galactoside-binding proteins that contribute to multiple cellular functions, including immune surveillance and apoptosis. Human galectins are also important regulators of inflammation, making them a research target for various inflammatory diseases and tumorigenesis associated with pro-inflammatory conditions. This review focuses on the involvement of human galectins in modulation of inflammation and in the pathophysiology of endometriosis and endometriosis-associated neoplasms. Endometriosis is a chronic inflammatory disease with unknown etiology. Galectins-1, -3 and -9 were found to be overexpressed in ectopic and eutopic endometrium of females with endometriosis compared to those without endometriosis. These findings suggest galectins’ role in the progression on endometriotic lesions and their potential use as diagnostic biomarkers and/or targets for therapeutic approaches. Galectins-1, -3, and -9 have also been implicated in the development of endometriosis-associated neoplasms. Furthermore, galectin-3 has been shown to interact with KRAS protein and contribute to cellular growth, proliferation, inflammation, and the uptake of nutrients in endometriotic lesions and may be involved in the maintenance and propagation of endometriosis. These galectins have been shown to be upregulated in certain forms of cervical, ovarian, endometrial, and colon cancer associated with endometriosis and have become a potential target for anti-cancer therapies.
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Affiliation(s)
- Brooke V. Hisrich
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC 29605, USA; (B.V.H.); (R.B.Y.); (A.M.S.)
| | - R. Brant Young
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC 29605, USA; (B.V.H.); (R.B.Y.); (A.M.S.)
| | - Alison M. Sansone
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC 29605, USA; (B.V.H.); (R.B.Y.); (A.M.S.)
| | - Zachary Bowens
- Department of Obstetrics and Gynecology, Prisma Health, Division of Reproductive Endocrinology and Infertility, Greenville, SC 29605, USA; (Z.B.); (L.J.G.); (B.A.L.)
| | - Lisa J. Green
- Department of Obstetrics and Gynecology, Prisma Health, Division of Reproductive Endocrinology and Infertility, Greenville, SC 29605, USA; (Z.B.); (L.J.G.); (B.A.L.)
| | - Bruce A. Lessey
- Department of Obstetrics and Gynecology, Prisma Health, Division of Reproductive Endocrinology and Infertility, Greenville, SC 29605, USA; (Z.B.); (L.J.G.); (B.A.L.)
- Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Anna V. Blenda
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC 29605, USA; (B.V.H.); (R.B.Y.); (A.M.S.)
- Correspondence: ; Tel.: +1-864-455-7998
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Symons LK, Miller JE, Tyryshkin K, Monsanto SP, Marks RM, Lingegowda H, Vanderbeck K, Childs T, Young SL, Lessey BA, Koti M, Tayade C. Neutrophil recruitment and function in endometriosis patients and a syngeneic murine model. FASEB J 2019; 34:1558-1575. [PMID: 31914688 DOI: 10.1096/fj.201902272r] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/08/2019] [Accepted: 11/15/2019] [Indexed: 02/06/2023]
Abstract
Endometriosis is a chronic inflammatory, gynecological disease characterized by the presence of endometrial-like tissue lesions outside of the uterus. Neutrophils are elevated in the systemic circulation and peritoneal fluid of endometriosis patients; however, whether and how neutrophils contribute to endometriosis pathophysiology remain poorly understood. With emerging roles for neutrophils in chronic and sterile inflammatory conditions, we sought to provide in-depth characterization of neutrophil involvement in endometriosis. We demonstrate that neutrophils reside within patient endometriotic lesions and that patient lesions possess a microenvironment that may influence neutrophil recruitment and function. We also provide the first evidence that systemic circulating neutrophils from endometriosis patients display distinct transcriptomic differences compared neutrophils from healthy control subjects. Time course characterization of our syngeneic, immunocompetent mouse model of endometriosis revealed that neutrophils are rapidly recruited to the peritoneal environment early after endometriotic lesion establishment and remain present in murine lesions long term. In vivo neutrophil depletion altered the systemic and peritoneal immune microenvironment of mice with endometriosis as demonstrated by changes in pro-inflammatory and angiogenic mediators. Taken together, these findings highlight a novel role for neutrophils in early events such as angiogenesis and modulation of the local inflammatory environment associated with endometriosis pathogenesis.
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Affiliation(s)
- Lindsey K Symons
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Jessica E Miller
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Kathrin Tyryshkin
- Department of Pathology and Molecular Medicine, Kingston Health Sciences Center, Kingston, ON, Canada
| | - Stephany P Monsanto
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Ryan M Marks
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | | | - Kaitlin Vanderbeck
- Department of Pathology and Molecular Medicine, Kingston Health Sciences Center, Kingston, ON, Canada
| | - Timothy Childs
- Department of Pathology and Molecular Medicine, Kingston Health Sciences Center, Kingston, ON, Canada
| | - Steven L Young
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | | | - Madhuri Koti
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada.,Department of Obstetrics and Gynecology, Kingston Health Sciences Center, Kingston, ON, Canada.,Division of Cancer Biology and Genetics, Queen's University, Kingston, ON, Canada
| | - Chandrakant Tayade
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
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31
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Fox CW, Savaris RF, Jeong JW, Kim TH, Miller PB, Likes CE, Schammel DP, Young SL, Lessey BA. Unexplained recurrent pregnancy loss and unexplained infertility: twins in disguise. Hum Reprod Open 2019; 2020:hoz021. [PMID: 36694811 PMCID: PMC9869655 DOI: 10.1093/hropen/hoz021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 07/07/2019] [Indexed: 01/27/2023] Open
Abstract
STUDY QUESTION Is B-cell CLL/lymphoma 6 (BCL6) endometrial expression, a surrogate biomarker of endometriosis, elevated in women with unexplained recurrent pregnancy loss (uRPL) and unexplained infertility (UI) compared to fertile subjects? SUMMARY ANSWER Endometrial BCL6 expression is elevated to a similar degree in women with uRPL and UI compared to fertile controls. WHAT IS KNOWN ALREADY Endometriosis has been linked to the genesis of endometrial progesterone resistance and to specific nuclear proteins, including endometrial BCL6. BCL6 overexpression (immune histologic score > 1.4) has been strongly associated with poor reproductive outcomes in IVF cycles in women with UI. Our previous data have demonstrated an accuracy of 94% for diagnosing endometriosis, and BCL6 protein is elevated in the decidua of women with uRPL. STUDY DESIGN SIZE DURATION In this case-control study, at a tertiary university teaching hospital, 110 samples (control n = 28; uRPL n = 29; UI n = 53) from pathological archives were analyzed. Timed endometrial biopsies were obtained between 2 January 2002 and 31 December 2016. PARTICIPANTS/MATERIALS SETTING METHOD LH-timed endometrial biopsies were obtained from women with UI, uRPL (two or more consecutive losses) and normal fertile subjects during the mid-secretory phase of the menstrual cycle. Endometrial BCL6 protein levels were compared in women with UI and uRPL and fertile controls using western blot analysis and immunohistochemistry (HSCORE). MAIN RESULTS AND THE ROLE OF CHANCE The mean age of the uRPL group was significantly higher than the others [mean (SD)] control = 32.7 (2.6); uRPL = 35.8 (3.7); UI = 32.7 (4.4); P = 0.002, ANOVA]. Seventy-nine percent of women in both subfertile groups (uRPL and UI, 65 out of 82) displayed elevated BCL6 protein levels. From these, a subset of cases with abnormal BCL6 went to laparoscopy and endometriosis was found in 9 out of 11 cases of uRPL and in 20 out of 21 cases of UI. Median BCL6 HSCORE for controls versus uRPL and UI was significantly different [median (interquartile); control = 0.3 (0.02 to 0.5); uRPL = 3 (1.9 to 3.6); UI = 2.9 (1.6 to 3.1); P < 0.0001, Kruskal-Wallis]. A significant trend in the association between the degree of infertility (fertile, uRPL and UI) and the HSCORE level (negative, medium and high) was found (P < 0.001; x 2 for trend). Western blot of representative samples from each group demonstrated similar findings based on protein levels in the whole endometrium. After running ANCOVA analysis for age difference, the BCL6 difference among groups was still significant (P-value < 0.0001). LIMITATIONS REASONS FOR CAUTION We studied subjects with two consecutive pregnancy losses rather than the definition adopted in Europe of three losses. The findings may lack external validity in other clinical settings (e.g. low prevalence of endometriosis). WIDER IMPLICATIONS OF THE FINDINGS Based on the data presented here, we postulate that the degree of BCL6 expression may represent a continuum of progesterone resistance and response to inflammation that occurs in women with endometriosis, yielding different degrees of infertility, from uRPL to UI. STUDY FUNDING/COMPETING INTERESTS This study was supported by NICHD/NIH R01 HD067721 (SLY and BAL), by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior: Grant 99999.003035/2015-08 (BAL) and by CAPES/PROAP (RFS). Two authors (BAL, SLY) have licensed intellectual property for the detection of endometriosis. Dr Bruce Lessey is an unpaid scientific Advisor for CiceroDx. The other authors report no conflict of interest.
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Affiliation(s)
- Chelsea W Fox
- University of San Diego, Department of Obstetrics and Gynecology, San Diego, CA, USA
| | - Ricardo F Savaris
- Departamento de Ginecologia e Obstetrícia, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-903, Brazil
| | - Jae-Wook Jeong
- Obstetrics, Gynecology and Reproductive Biology of Michigan State University, Grand Rapids, MI 49503, USA
| | - Tae Hoon Kim
- Obstetrics, Gynecology and Reproductive Biology of Michigan State University, Grand Rapids, MI 49503, USA
| | - Paul B Miller
- Obstetrics and Gynecology, Greenville Health System, Greenville, SC 29605, USA
| | - Creighton E Likes
- Obstetrics and Gynecology, Greenville Health System, Greenville, SC 29605, USA
| | - David P Schammel
- Pathology Associates, Greenville Health System, Greenville, SC, USA
| | - Steven L Young
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Bruce A Lessey
- Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Wake Forest Health, Winston-Salem, NC 27157, USA
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Khalaj K, Miller JE, Lingegowda H, Fazleabas AT, Young SL, Lessey BA, Koti M, Tayade C. Extracellular vesicles from endometriosis patients are characterized by a unique miRNA-lncRNA signature. JCI Insight 2019; 4:128846. [PMID: 31534048 DOI: 10.1172/jci.insight.128846] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 08/08/2019] [Indexed: 12/17/2022] Open
Abstract
With multifactorial etiologies, combined with disease heterogeneity and a lack of suitable diagnostic markers and therapy, endometriosis remains a major reproductive health challenge. Extracellular vesicles (EVs) have emerged as major contributors of disease progression in several conditions, including a variety of cancers; however, their role in endometriosis pathophysiology has remained elusive. Using next-generation sequencing of EVs obtained from endometriosis patient tissues and plasma samples compared with controls, we have documented that patient EVs carry unique signatures of miRNAs and long noncoding RNAs (lncRNAs) reflecting their contribution to disease pathophysiology. Mass spectrophotometry-based proteomic analysis of EVs from patient plasma and peritoneal fluid further revealed enrichment of specific pathways, as well as altered immune and metabolic processes. Functional studies in endometriotic epithelial and endothelial cell lines using EVs from patient plasma and controls clearly indicate autocrine uptake and paracrine cell proliferative roles, suggestive of their involvement in endometriosis. Multiplex cytokine analysis of cell supernatants in response to patient and control plasma-derived EVs indicate robust signatures of important inflammatory and angiogenic cytokines known to be involved in disease progression. Collectively, these findings suggest that endometriosis-associated EVs carry unique cargo and contribute to disease pathophysiology by influencing inflammation, angiogenesis, and proliferation within the endometriotic lesion microenvironment.
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Affiliation(s)
- Kasra Khalaj
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Jessica E Miller
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | | | - Asgerally T Fazleabas
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
| | - Steven L Young
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Bruce A Lessey
- Department of Obstetrics and Gynecology, Greenville Health Systems, Greenville, South Carolina, USA
| | - Madhuri Koti
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada.,Department of Obstetrics and Gynecology and.,Division of Cancer Biology and Genetics, Queen's University, Kingston, Ontario, Canada
| | - Chandrakant Tayade
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
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Abstract
Endometrial receptivity is a complex process that provides the embryo with the opportunity to attach, invade, and develop, culminating in a new individual and continuation of the species. The window of implantation extends 3-6 days within the secretory phase in most normal women. In certain inflammatory or anatomic conditions, this window is narrowed or shifted to preclude normal implantation, leading to infertility or pregnancy loss. Of the factors that prevent normal implantation and pregnancy, embryo and endometrial quality share responsibility. In this review, we highlight the advances in the study of implantation from the perspective of the endometrium, normally a barrier to implantation. New advances will allow the early identification of defects in endometrial receptivity and provide new avenues for treatment that promote successful establishment of pregnancy.
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Affiliation(s)
- Bruce A Lessey
- Department of Obstetrics and Gynecology, Wake Forest Baptist Health, Winston-Salem, North Carolina.
| | - Steven L Young
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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34
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Likes CE, Cooper LJ, Efird J, Forstein DA, Miller PB, Savaris R, Lessey BA. Medical or surgical treatment before embryo transfer improves outcomes in women with abnormal endometrial BCL6 expression. J Assist Reprod Genet 2019; 36:483-490. [PMID: 30610661 PMCID: PMC6439015 DOI: 10.1007/s10815-018-1388-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 12/14/2018] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To evaluate the effect of medical or surgical treatment prior to embryo transfer in women with elevated endometrial BCL6 expression and suspected endometriosis in a prospective, cohort study design at a university-associated infertility clinic. METHODS All subjects had at least 1 year of unexplained infertility (UI) and each prospectively underwent endometrial biopsy and immunostaining for the oncogene BCL6, prior to embryo transfer during an assisted reproductive technology (ART) cycle. To be included, subjects had to have an abnormal BCL6 result, defined by elevated HSCORE ≥ 1.4. Women that were pre-treated with laparoscopy or medical suppression with GnRH agonist (depot leuprolide acetate; Lupron®, Abbvie, Inc., Chicago, IL) for 2 months were compared to a group that went untreated (controls). Endpoints included implantation rate (IR), clinical pregnancy rate (CPR), and live birth rate (LBR), and as well as cycle characteristics. Miscarriage rate were also compared between treatment and control group. RESULTS Women in each group had similar characteristics. Those treated by medical suppression and those undergoing laparoscopy for endometriosis had a significantly higher LBR, (5/10; 50%; 95%CI 23.7 to 76.3%) and (11/21; 52.4%; 95%CI 32.4 to 71.7), respectively, compared to controls (4/54; 7.4%; 95%CI 2.9 to 17.6). An absolute benefit of 44.2% (16/31; 95%CI 24.6 to 61.2) and a number need to treat of 3 for those that received treatment (medical suppression and laparoscopy), compared to no treatment. Miscarriages were significantly more common in the control group. CONCLUSIONS Women with suspected endometriosis and aberrant endometrial BCL6 expression have worse reproductive outcomes following embryo transfer, including a high miscarriage rate, poor IR, and low LBR and CPR compared to cycles pre-treated with medical and surgical management.
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Affiliation(s)
- Creighton E Likes
- Department of Obstetrics and Gynecology, Greenville Health System, 890 W. Faris Rd, Ste 470, Greenville, SC, 29605, USA
| | - Leah J Cooper
- Obstetrics and Gynecology, University of South Carolina SOM-Greenville, 900 Grove Rd, Greenville, SC, USA
| | - Jessica Efird
- Obstetrics and Gynecology, University of South Carolina SOM-Greenville, 900 Grove Rd, Greenville, SC, USA
| | - David A Forstein
- Department of Obstetrics and Gynecology, Greenville Health System, 890 W. Faris Rd, Ste 470, Greenville, SC, 29605, USA
| | - Paul B Miller
- Department of Obstetrics and Gynecology, Greenville Health System, 890 W. Faris Rd, Ste 470, Greenville, SC, 29605, USA
| | - Ricardo Savaris
- Departamento de Ginecologia e Obstetrícia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90035-903, Brazil
| | - Bruce A Lessey
- Department of Obstetrics and Gynecology, Greenville Health System, 890 W. Faris Rd, Ste 470, Greenville, SC, 29605, USA.
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35
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Vasquez YM, Wang X, Wetendorf M, Franco HL, Mo Q, Wang T, Lanz RB, Young SL, Lessey BA, Spencer TE, Lydon JP, DeMayo FJ. FOXO1 regulates uterine epithelial integrity and progesterone receptor expression critical for embryo implantation. PLoS Genet 2018; 14:e1007787. [PMID: 30452456 PMCID: PMC6277115 DOI: 10.1371/journal.pgen.1007787] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 12/03/2018] [Accepted: 10/25/2018] [Indexed: 12/11/2022] Open
Abstract
Successful embryo implantation requires a receptive endometrium. Poor uterine receptivity can account for implantation failure in women who experience recurrent pregnancy loss or multiple rounds of unsuccessful in vitro fertilization cycles. Here, we demonstrate that the transcription factor Forkhead Box O1 (FOXO1) is a critical regulator of endometrial receptivity in vivo. Uterine ablation of Foxo1 using the progesterone receptor Cre (PgrCre) mouse model resulted in infertility due to altered epithelial cell polarity and apoptosis, preventing the embryo from penetrating the luminal epithelium. Analysis of the uterine transcriptome after Foxo1 ablation identified alterations in gene expression for transcripts involved in the activation of cell invasion, molecular transport, apoptosis, β-catenin (CTNNB1) signaling pathway, and an increase in PGR signaling. The increase of PGR signaling was due to PGR expression being retained in the uterine epithelium during the window of receptivity. Constitutive expression of epithelial PGR during this receptive period inhibited expression of FOXO1 in the nucleus of the uterine epithelium. The reciprocal expression of PGR and FOXO1 was conserved in human endometrial samples during the proliferative and secretory phase. This demonstrates that expression of FOXO1 and the loss of PGR during the window of receptivity are interrelated and critical for embryo implantation.
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Affiliation(s)
- Yasmin M. Vasquez
- Department of Molecular and Cellular Biology and Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - Xiaoqiu Wang
- Reproductive and Developmental Biology Laboratory, National Institute of Environmental Health Sciences, Research Triangle Park, NC, United States of America
- Department of Animal Science, North Carolina State University, Raleigh, NC, United States of America
| | - Margeaux Wetendorf
- Reproductive and Developmental Biology Laboratory, National Institute of Environmental Health Sciences, Research Triangle Park, NC, United States of America
| | - Heather L. Franco
- Department of Molecular and Cellular Biology and Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - Qianxing Mo
- Department of Medicine and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, United States of America
| | - Tianyuan Wang
- Reproductive and Developmental Biology Laboratory, National Institute of Environmental Health Sciences, Research Triangle Park, NC, United States of America
| | - Rainer B. Lanz
- Department of Molecular and Cellular Biology and Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - Steven L. Young
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, United States of America
| | - Bruce A. Lessey
- Department of Obstetrics and Gynecology, University of South Carolina School of Medicine, Greenville, SC, United States of America
| | - Thomas E. Spencer
- Division of Animal Science, University of Missouri, Columbia, MO, United States of America
| | - John P. Lydon
- Department of Molecular and Cellular Biology and Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - Francesco J. DeMayo
- Reproductive and Developmental Biology Laboratory, National Institute of Environmental Health Sciences, Research Triangle Park, NC, United States of America
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36
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Wang X, Li X, Wang T, Wu SP, Jeong JW, Kim TH, Young SL, Lessey BA, Lanz RB, Lydon JP, DeMayo FJ. SOX17 regulates uterine epithelial-stromal cross-talk acting via a distal enhancer upstream of Ihh. Nat Commun 2018; 9:4421. [PMID: 30356064 PMCID: PMC6200785 DOI: 10.1038/s41467-018-06652-w] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 08/31/2018] [Indexed: 02/07/2023] Open
Abstract
Mammalian pregnancy depends on the ability of the uterus to support embryo implantation. Previous studies reveal the Sox17 gene as a downstream target of the Pgr-Gata2-dependent transcription network that directs genomic actions in the uterine endometrium receptive for embryo implantation. Here, we report that ablating Sox17 in the uterine epithelium impairs leukemia inhibitory factor (LIF) and Indian hedgehog homolog (IHH) signaling, leading to failure of embryo implantation. In vivo deletion of the SOX17-binding region 19 kb upstream of the Ihh locus by CRISPR-Cas technology reduces Ihh expression specifically in the uterus and alters proper endometrial epithelial-stromal interactions, thereby impairing pregnancy. This SOX17-binding interval is also bound by GATA2, FOXA2, and PGR. This cluster of transcription factor binding is common in 737 uterine genes and may represent a key regulatory element essential for uterine epithelial gene expression.
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Affiliation(s)
- Xiaoqiu Wang
- Reproductive and Development Biology Laboratory, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
- Department of Animal Science, North Carolina State University, Raleigh, NC, USA
| | - Xilong Li
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
- Feed Research Institute, Chinese Academy of Agricultural Sciences, Beijing, China
| | - Tianyuan Wang
- Integrative Bioinformatics Support Group, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - San-Pin Wu
- Reproductive and Development Biology Laboratory, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Jae-Wook Jeong
- Department of Obstetrics and Gynecology and Reproductive Biology, Michigan State University, Grand Rapids, MI, USA
| | - Tae Hoon Kim
- Department of Obstetrics and Gynecology and Reproductive Biology, Michigan State University, Grand Rapids, MI, USA
| | - Steven L Young
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - Bruce A Lessey
- Deptartment of Obstetrics and Gynecology, University of South Carolina School of Medicine, Greenville, SC, USA
| | - Rainer B Lanz
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
| | - John P Lydon
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
| | - Francesco J DeMayo
- Reproductive and Development Biology Laboratory, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA.
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37
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Matson BC, Quinn KE, Lessey BA, Young SL, Caron KM. Elevated levels of adrenomedullin in eutopic endometrium and plasma from women with endometriosis. Fertil Steril 2018; 109:1072-1078. [PMID: 29871794 DOI: 10.1016/j.fertnstert.2018.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 01/22/2018] [Accepted: 02/02/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To test adrenomedullin (Adm, ADM) as a downstream target of signal transducer and activator of transcription 3 (STAT3) in endometrial cells and to test midregional proadrenomedullin (MR-proADM) as a biomarker of endometriosis. DESIGN Cross-sectional analysis of Adm expression in eutopic endometrium and of MR-proADM in plasma from women with and without endometriosis; and prospective study of MR-proADM levels in women with endometriosis undergoing surgical resection of ectopic lesions. SETTING Academic medical centers. PATIENT(S) Fifteen patients with endometriosis and 11 healthy control subjects who donated eutopic endometrial biopsies; and 28 patients with endometriosis and 19 healthy control subjects who donated plasma for MR-proADM analysis. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Adm mRNA levels according to quantitative real-time polymerase chain reaction after activation of STAT3 by interleukin-6 (IL-6) in Ishikawa cells; immunohistochemistry for ADM in eutopic endometrial biopsies from women with endometriosis compared with healthy donors; and MR-proADM levels measured by commercial immunoassay in plasma from healthy women and women with endometriosis who subsequently underwent surgical resection of ectopic lesions. RESULT(S) Activation of STAT3 by IL-6 up-regulated Adm mRNA expression in Ishikawa cells. ADM protein levels were elevated in the eutopic endometrium of women with endometriosis. MR-proADM concentrations were higher in women with endometriosis but were not correlated with disease stage, corrected by surgery, or predictive of fertility outcome. CONCLUSION(S) MR-proADM may be able to serve as a biomarker of endometriosis, but it is unknown whether elevated MR-proADM levels are secondary to the estrogenic and inflammatory properties of endometriosis or an inciting pathogenic factor.
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Affiliation(s)
- Brooke C Matson
- Department of Cell Biology and Physiology, University of North Carolina, Chapel Hill, North Carolina
| | - Kelsey E Quinn
- Department of Cell Biology and Physiology, University of North Carolina, Chapel Hill, North Carolina
| | - Bruce A Lessey
- Obstetrics and Gynecology, Greenville Health System, Greenville, South Carolina
| | - Steven L Young
- Department of Cell Biology and Physiology, University of North Carolina, Chapel Hill, North Carolina; Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
| | - Kathleen M Caron
- Department of Cell Biology and Physiology, University of North Carolina, Chapel Hill, North Carolina.
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Zhang T, Zhou J, Man GCW, Leung KT, Liang B, Xiao B, Ma X, Huang S, Huang H, Hegde VL, Zhong Y, Li Y, Kong GWS, Yiu AKW, Kwong J, Ng PC, Lessey BA, Nagarkatti PS, Nagarkatti M, Wang CC. MDSCs drive the process of endometriosis by enhancing angiogenesis and are a new potential therapeutic target. Eur J Immunol 2018; 48:1059-1073. [PMID: 29460338 DOI: 10.1002/eji.201747417] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/20/2018] [Accepted: 02/14/2018] [Indexed: 12/21/2022]
Abstract
Endometriosis affects women of reproductive age via unclear immunological mechanism(s). Myeloid-derived suppressor cells (MDSCs) are a heterogeneous group of myeloid cells with potent immunosuppressive and angiogenic properties. Here, we found MDSCs significantly increased in the peripheral blood of patients with endometriosis and in the peritoneal cavity of a mouse model of surgically induced endometriosis. Majority of MDSCs were granulocytic, produced ROS, and arginase, and suppressed T-cell proliferation. Depletion of MDSCs by antiGr-1 antibody dramatically suppressed development of endometrial lesions in mice. The chemokines CXCL1, 2, and 5 were expressed at sites of lesion while MDSCs expressed CXCR-2. These CXC-chemokines promoted MDSC migration toward endometriotic implants both in vitro and in vivo. Also, CXCR2-deficient mice show significantly decreased MDSC induction, endometrial lesions, and angiogenesis. Importantly, adoptive transfer of MDSCs into CXCR2-KO mice restored endometriotic growth and angiogenesis. Together, this study demonstrates that MDSCs play a role in the pathogenesis of endometriosis and identifies a novel CXC-chemokine and receptor for the recruitment of MDSCs, thereby providing a potential target for endometriosis treatment.
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Affiliation(s)
- Tao Zhang
- Department of Obstetrics and Gynaecology, the Chinese University of Hong Kong, Hong Kong
| | - Juhua Zhou
- Institute for Tumor Immunology, School of Life Sciences, Ludong University, Yantai, Shandong, China
| | - Gene Chi Wai Man
- Department of Obstetrics and Gynaecology, the Chinese University of Hong Kong, Hong Kong
| | - Kam Tong Leung
- Department of Paediatrics, the Chinese University of Hong Kong, Hong Kong
| | - Bo Liang
- Department of Obstetrics and Gynaecology, the Chinese University of Hong Kong, Hong Kong
| | - Bo Xiao
- Institute for Tumor Immunology, School of Life Sciences, Ludong University, Yantai, Shandong, China
| | - Xinting Ma
- Institute for Tumor Immunology, School of Life Sciences, Ludong University, Yantai, Shandong, China
| | - Shaoyan Huang
- Department of Oncology, Yantai Mountain Hospital, Yantai, Shandong, China
| | | | - Venkatesh L Hegde
- Department of Obstetrics and Gynecology, Greenville Health Systems, Greenville, South Carolina, SC, USA
| | - Yin Zhong
- Department of Obstetrics and Gynecology, Greenville Health Systems, Greenville, South Carolina, SC, USA
| | - Yanmin Li
- Institute for Tumor Immunology, School of Life Sciences, Ludong University, Yantai, Shandong, China
| | - Grace Wing Shan Kong
- Department of Obstetrics and Gynaecology, the Chinese University of Hong Kong, Hong Kong
| | - Alice Ka Wah Yiu
- Department of Obstetrics and Gynaecology, the Chinese University of Hong Kong, Hong Kong
| | - Joseph Kwong
- Department of Obstetrics and Gynaecology, the Chinese University of Hong Kong, Hong Kong
| | - Pak Cheung Ng
- Department of Paediatrics, the Chinese University of Hong Kong, Hong Kong
| | - Bruce A Lessey
- Department of Obstetrics and Gynecology, Greenville Health Systems, Greenville, South Carolina, SC, USA
| | - Prakash S Nagarkatti
- Department of Pathology, Microbiology and Immunology, School of Medicine, University of South Carolina, Columbia, SC, USA
| | - Mitzi Nagarkatti
- Department of Pathology, Microbiology and Immunology, School of Medicine, University of South Carolina, Columbia, SC, USA
| | - Chi Chiu Wang
- Department of Obstetrics and Gynaecology, the Chinese University of Hong Kong, Hong Kong.,Li Ka Shing Institute of Health Sciences, the Chinese University of Hong Kong, Hong Kong.,School of Biomedical Sciences, the Chinese University of Hong Kong, Hong Kong
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Palomino WA, Tayade C, Argandoña F, Devoto L, Young SL, Lessey BA. The endometria of women with endometriosis exhibit dysfunctional expression of complement regulatory proteins during the mid secretory phase. J Reprod Immunol 2018; 125:1-7. [DOI: 10.1016/j.jri.2017.10.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 08/21/2017] [Accepted: 10/23/2017] [Indexed: 01/19/2023]
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Strug MR, Su RW, Kim TH, Mauriello A, Ticconi C, Lessey BA, Young SL, Lim JM, Jeong JW, Fazleabas AT. RBPJ mediates uterine repair in the mouse and is reduced in women with recurrent pregnancy loss. FASEB J 2018; 32:2452-2466. [PMID: 29242273 DOI: 10.1096/fj.201701032r] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Unexplained recurrent pregnancy loss (uRPL) is associated with repeated embryo loss and endometrial repair with elevated endometrial expression of inflammatory cytokines, including IFN-γ. Notch signaling through its transcription factor recombination signal binding protein Jκ (RBPJ) regulates mechanisms including the immune response and repair after tissue injury. Initially, null mutation of RBPJ in the mouse uterus ( Pgrcre/+Rbpjf/f; Rbpj c-KO) results in subfertility, but we have found that these mice become infertile after pregnancy as a result of dysfunctional postpartum uterine repair, including delayed endometrial epithelial and myometrial regeneration. RNA sequencing of postpartum uterine repair sites revealed global up-regulation of inflammatory pathways, including IFN signaling. Consistent with elevated IFN-γ, macrophages were recruited and polarized toward an M1-cytotoxic phenotype, which is associated with preventing repair and promoting further tissue injury. Through embryo transfer experiments, we show that dysfunctional postpartum repair directly impairs future embryo implantation in Rbpj c-KO mice. Last, we clinically correlated our findings from the Rbpj c-KO mouse in women diagnosed with uRPL. Reduced RBPJ in women with uRPL was associated with increased levels of IFN-γ. The data, taken together, indicate that RBPJ regulates inflammation during endometrial repair, which is essential for future pregnancy potential, and its dysregulation may serve as an unidentified contributor to uRPL in women.-Strug, M. R., Su, R.-W., Kim, T. H., Mauriello, A., Ticconi, C., Lessey, B. A., Young, S. L., Lim, J. M., Jeong, J.-W., Fazleabas, A. T. RBPJ mediates uterine repair in the mouse and is reduced in women with recurrent pregnancy loss.
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Affiliation(s)
- Michael R Strug
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, Grand Rapids, Michigan, USA
| | - Ren-Wei Su
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, Grand Rapids, Michigan, USA.,College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
| | - Tae Hoon Kim
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, Grand Rapids, Michigan, USA
| | - Alessandro Mauriello
- Section of Gynecology and Obstetrics, Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Carlo Ticconi
- Section of Gynecology and Obstetrics, Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Bruce A Lessey
- Department of Obstetrics and Gynecology, Greenville Health System, Greenville, South Carolina, USA
| | - Steven L Young
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jeong Mook Lim
- World Class University (WCU) Biomodulation, Department of Agricultural Biotechnology, Seoul National University, Seoul, South Korea
| | - Jae-Wook Jeong
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, Grand Rapids, Michigan, USA
| | - Asgerally T Fazleabas
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, Grand Rapids, Michigan, USA
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41
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Miller JE, Monsanto SP, Ahn SH, Khalaj K, Fazleabas AT, Young SL, Lessey BA, Koti M, Tayade C. Interleukin-33 modulates inflammation in endometriosis. Sci Rep 2017; 7:17903. [PMID: 29263351 PMCID: PMC5738435 DOI: 10.1038/s41598-017-18224-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 12/07/2017] [Indexed: 01/05/2023] Open
Abstract
Endometriosis is a debilitating condition that is categorized by the abnormal growth of endometrial tissue outside the uterus. Although the pathogenesis of this disease remains unknown, it is well established that endometriosis patients exhibit immune dysfunction. Interleukin (IL)-33 is a danger signal that is a critical regulator of chronic inflammation. Although plasma and peritoneal fluid levels of IL-33 have been associated with deep infiltrating endometriosis, its contribution to the disease pathophysiology is unknown. We investigated the role of IL-33 in the pathology of endometriosis using patient samples, cell lines and a syngeneic mouse model. We found that endometriotic lesions produce significantly higher levels of IL-33 compared to the endometrium of healthy, fertile controls. In vitro stimulation of endometrial epithelial, endothelial and endometriotic epithelial cells with IL-33 led to the production of pro-inflammatory and angiogenic cytokines. In a syngeneic mouse model of endometriosis, IL-33 injections caused systemic inflammation, which manifested as an increase in plasma pro-inflammatory cytokines compared to control mice. Furthermore, endometriotic lesions from IL-33 treated mice were highly vascularized and exhibited increased proliferation. Collectively, we provide convincing evidence that IL-33 perpetuates inflammation, angiogenesis and lesion proliferation, which are critical events in the lesion survival and progression of endometriosis.
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Affiliation(s)
- Jessica E Miller
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, K7L 3N6, Canada
| | - Stephany P Monsanto
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, K7L 3N6, Canada
| | - Soo Hyun Ahn
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, K7L 3N6, Canada
| | - Kasra Khalaj
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, K7L 3N6, Canada
| | - Asgerally T Fazleabas
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University College of Human Medicine, Grand Rapids, MI, 49503, USA
| | - Steven L Young
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, NC, 27514, USA
| | - Bruce A Lessey
- Department of Obstetrics and Gynecology, Greenville Health Systems, Greenville, South Carolina, SC, 29605, USA
| | - Madhuri Koti
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, K7L 3N6, Canada
| | - Chandrakant Tayade
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, K7L 3N6, Canada.
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42
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Affiliation(s)
- Bruce A Lessey
- Fertility Center of the Carolinas, Greenville Health System, Greenville, South Carolina
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43
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Almquist LD, Likes CE, Stone B, Brown KR, Savaris R, Forstein DA, Miller PB, Lessey BA. Endometrial BCL6 testing for the prediction of in vitro fertilization outcomes: a cohort study. Fertil Steril 2017; 108:1063-1069. [PMID: 29126613 PMCID: PMC5726554 DOI: 10.1016/j.fertnstert.2017.09.017] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 08/25/2017] [Accepted: 09/14/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To evaluate endometrial BCL6 expression as a prognostic biomarker for IVF outcome in women with unexplained infertility (UI) before ET. DESIGN Prospective cohort study. SETTING University-associated infertility clinic. PATIENT(S) Women with UI for >1 year. INTERVENTION(S) We studied women with UI who underwent testing for endometrial BCL6, in an LH-timed midluteal phase biopsy and completed an IVF cycle and ET. MAIN OUTCOME MEASURE(S) Clinical pregnancy rate (PR) and live birth rate per transfer was compared for women positive or negative for BCL6 expression. An abnormal BCL6 result was defined by an histologic score (>1.4). RESULT(S) Women with normal and abnormal BCL6 and those who conceived or not had similar characteristics. Women with low levels of BCL6 expression had a significantly higher clinical PR (11/17; 64.7%; 95% confidence interval [CI] 41.3-82.6) compared with women with abnormal (high) BCL6 expression (9/52; 17.3%; 95% CI 9.3-30.8). These results yield a relative risk of 0.267 (95% CI 0.13-0.53; P=.0004) for those with normal BCL6 expression, an absolute benefit of 47.4% (95% CI 22.5-72.0). Live birth rate was also significantly higher in women with low BCL6 expression (10/17; 58.8%; 95% CI 36.0-78.4) compared with women with abnormal BCL6 expression (6/52; 11.5%; 95% CI 5.4-23.0). The relative risk was 0.19 (95% CI 0.08-0.45; P=.0002), yielding an absolute benefit of 47.3% (95% CI 21.8-67.8). CONCLUSION(S) Aberrant BCL6 expression (histologic score, >1.4) was strongly associated with poor reproductive outcomes in IVF cycles in women with UI.
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Affiliation(s)
- Laura D Almquist
- Department of Obstetrics and Gynecology, Greenville Health System, Greenville, South Carolina
| | - Creighton E Likes
- Department of Obstetrics and Gynecology, Greenville Health System, Greenville, South Carolina
| | - Benjamin Stone
- Department of Biology, Bowdoin College, Brunswick, Maine
| | - Kaitlin R Brown
- Obstetrics and Gynecology, University of South Carolina SOM-Greenville, Greenville, South Carolina
| | - Ricardo Savaris
- Departamento de Ginecologia e Obstetrícia, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil
| | - David A Forstein
- Department of Obstetrics and Gynecology, Greenville Health System, Greenville, South Carolina
| | - Paul B Miller
- Department of Obstetrics and Gynecology, Greenville Health System, Greenville, South Carolina
| | - Bruce A Lessey
- Department of Obstetrics and Gynecology, Greenville Health System, Greenville, South Carolina.
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44
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Young SL, Savaris RF, Lessey BA, Sharkey AM, Balthazar U, Zaino RJ, Sherwin RA, Fritz MA. Effect of randomized serum progesterone concentration on secretory endometrial histologic development and gene expression. Hum Reprod 2017; 32:1903-1914. [PMID: 28854727 PMCID: PMC5850604 DOI: 10.1093/humrep/dex252] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/09/2017] [Accepted: 07/17/2017] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION What doses of secretory phase progesterone (P) in women are associated with altered endometrial structure and/or function? SUMMARY ANSWER Consistently delayed histological maturation was seen at the lowest tested daily P dose (2.5 mg), whereas consistently altered functional response, as reflected by microarray analysis of gene expression was seen at both the 5 and 2.5 mg doses. WHAT IS KNOWN ALREADY Progesterone is absolutely required for normal embryo implantation and pregnancy survival. Progesterone supplementation is beneficial in ART cycles. STUDY DESIGN, SIZE, DURATION In this case-control experimental trial, 46 healthy young female volunteers (age 19-34) underwent a single modeled endometrial cycle after GnRH down-regulation or monitored in natural cycles. PARTICIPANTS/MATERIALS, SETTING, METHODS In a university hospital, modeled cycles were obtained by GnRH agonist down-regulation, transdermal estradiol (E2) (0.2 mg/d), and daily injections of P in oil for 10 days: 2.5 mg (n = 6), 5 mg (n = 6), 10 mg (n = 12) or 40 mg (n = 12), after the 10th day of E2. Ten healthy, ovulatory women were used as controls. Endometrial biopsies were obtained on the 10th day of P exposure, or urinary LH surge (in controls). Analysis included histological dating, serum progesterone levels, microarray analysis of the whole genome, RT-PCR, western blot and comparison with the GEO database. MAIN RESULTS AND THE ROLE OF CHANCE In endometrial biopsies, a morphological delay appears in the 2.5 mg/day of P group. Higher sub-physiological levels of P (≥5 mg/day) resulted in normal histology, but aberrant gene expression. P levels required for consistent histological delay were lower than those in all ovulatory women. Gene expression abnormalities occurred at higher sub-physiological P concentrations, without a change in histology, a functional-morphological disassociation. The expression of some endometrial receptivity-associated genes appeared multiphasic, with peak or nadir of mean or median expression levels between the lowest and highest doses, suggesting sustained supraphysiological doses seen in ART treatment cycles may not be optimal. LARGE SCALE DATA GEO DataSets ID: 200056980; GSE 56980. LIMITATIONS, REASONS FOR CAUTION These results were obtained in fertile women, who may respond differently from infertile subjects. WIDER IMPLICATIONS OF THE FINDINGS The dose of P required for normal endometrial structure (5 mg/day) corresponds to a P concentration well below that seen in ovulatory women, suggesting that persistently delayed mid-secretory histology cannot be solely due to inadequate P concentrations in an ovulatory cycle. Endometrial gene expression is differentially regulated by different doses of progesterone. The apparent multiphasic response of some genes to P dose suggests the possibility that P concentration kinetics may play a role in normal endometrial preparation for receptivity. These findings strongly confirm that histologic development is not a reliable measure of endometrial P action. STUDY FUNDING/COMPETING INTEREST(S) Supported by The Eunice Kennedy Shriver National Institute for Child Health and Disease, National Institute of Health, USA (NICHD/NIH) (R01HD067721 and U54HD30476; SLY and BAL) and Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) 240239/2012-1 (RFS). All authors have no competing interests.
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Affiliation(s)
- Steven L. Young
- Department of Obstetrics and Gynecology (CB#7570), 101 Manning Dr, University of North Carolina at Chapel Hill, NC, USA
| | - Ricardo F. Savaris
- Departamento de Ginecologia e Obstetrícia, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2400, Porto Alegre, RS 90035-003, Brazil
| | - Bruce A. Lessey
- Department of Obstetrics and Gynecology, Greenville Health System, 890 W. Faris Rd (Ste 470), Greenville, SC 29605, USA
| | - Andrew M. Sharkey
- Department of Pathology, University of Cambridge, Tennis Court Rd, Cambridge CB2 1QP, UK
| | - Ursula Balthazar
- Department of Obstetrics and Gynecology (CB#7570), 101 Manning Dr, University of North Carolina at Chapel Hill, NC, USA
| | - Richard J. Zaino
- Department of Pathology, Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA
| | - Robert A. Sherwin
- Department of Obstetrics and Gynecology, The Whittington Hospital, National Health Service Trust, Magdala Ave, London N19 5 NF, UK
| | - Marc A. Fritz
- Department of Obstetrics and Gynecology (CB#7570), 101 Manning Dr, University of North Carolina at Chapel Hill, NC, USA
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Yoo JY, Kim TH, Fazleabas AT, Palomino WA, Ahn SH, Tayade C, Schammel DP, Young SL, Jeong JW, Lessey BA. KRAS Activation and over-expression of SIRT1/BCL6 Contributes to the Pathogenesis of Endometriosis and Progesterone Resistance. Sci Rep 2017; 7:6765. [PMID: 28754906 PMCID: PMC5533722 DOI: 10.1038/s41598-017-04577-w] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 05/31/2017] [Indexed: 01/04/2023] Open
Abstract
Endometriosis is an inflammatory condition that is associated with progesterone resistance and cell proliferation, resulting in pain, infertility and pregnancy loss. We previously demonstrated phosphorylation of STAT3 in eutopic endometrium of infertile women with this disorder leading to over-expression of the oncogene BCL6 and stabilization of hypoxia-induced factor 1 alpha (HIF-1α). Here we report coordinated activation of KRAS and over-expression of Sirtuin 1 (SIRT1), a histone deacetylase and gene silencer, in the eutopic endometrium from women with endometriosis throughout the menstrual cycle. The mice with conditional activation of KRAS in the PGR positive cells reveal an increase of SIRT1 expression in the endometrium compared to control mice. The expression of progesterone receptor target genes including the Indian Hedgehog pathway genes are significantly down-regulated in the mutant mice. SIRT1 co-localizes with BCL6 in the nuclei of affected individuals and both proteins bind to and suppress the promoter of GLI1, a critical mediator of progesterone action in the Indian Hedgehog pathway, by ChIP analysis. In eutopic endometrium, GLI1 expression is reduced in women with endometriosis. Together, these data suggest that KRAS, SIRT1 and BCL6 are coordinately over-expressed in eutopic endometrium of women with endometriosis and likely participate in the pathogenesis of endometriosis.
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Affiliation(s)
- Jung-Yoon Yoo
- Obstetrics, Gynecology & Reproductive Biology, Michigan State University, Grand Rapids, MI, 49503, USA
- Department of Biochemistry and Molecular Biology, Yonsei University College of Medicine, Seoul, 03722, South Korea
| | - Tae Hoon Kim
- Obstetrics, Gynecology & Reproductive Biology, Michigan State University, Grand Rapids, MI, 49503, USA
| | - Asgerally T Fazleabas
- Obstetrics, Gynecology & Reproductive Biology, Michigan State University, Grand Rapids, MI, 49503, USA
- Department of Women's Health, Spectrum Health System, Grand Rapids, MI, 49341, USA
| | - Wilder A Palomino
- Institute for Maternal and Child Research, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Soo Hyun Ahn
- Department of Biomedical and Molecular Sciences, Queens University, Kingston, ON K7L 3N6, Canada
| | - Chandrakant Tayade
- Department of Biomedical and Molecular Sciences, Queens University, Kingston, ON K7L 3N6, Canada
| | - David P Schammel
- Pathology Associates, Greenville Hospital System, Greenville, SC, 29605, USA
| | - Steven L Young
- Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, 27514, USA
| | - Jae-Wook Jeong
- Obstetrics, Gynecology & Reproductive Biology, Michigan State University, Grand Rapids, MI, 49503, USA.
- Department of Women's Health, Spectrum Health System, Grand Rapids, MI, 49341, USA.
| | - Bruce A Lessey
- Obstetrics and Gynecology, Greenville Health System, Greenville, SC, 29605, USA.
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46
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Khalaj K, Ahn SH, Bidarimath M, Nasirzadeh Y, Singh SS, Fazleabas AT, Young SL, Lessey BA, Koti M, Tayade C. A balancing act: RNA binding protein HuR/TTP axis in endometriosis patients. Sci Rep 2017; 7:5883. [PMID: 28724967 PMCID: PMC5517625 DOI: 10.1038/s41598-017-06081-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 06/07/2017] [Indexed: 12/12/2022] Open
Abstract
Endometriosis, a major reproductive pathology affecting 8-10% of women is characterized by chronic inflammation and immune dysfunction. Human antigen R (HuR) and Tristetraprolin (TTP) are RNA binding proteins that competitively bind to cytokines involved in inflammation including: tumor necrosis factor alpha (TNF-α), granulocyte macrophage colony stimulating factor (GM-CSF), interleukin 6 (IL-6) among others, and stabilize and destabilize them, respectively. The aim of this study was to examine RNA binding protein (RNABP) HuR/TTP axis in endometriosis patients compared to menstrual stage matched healthy fertile controls in hopes of better understanding their contribution to the pathogenesis of endometriosis. Additionally, using a targeted in vitro siRNA approach, we examined whether knock-down of TTP can play a functional role on other RNABPs that competitively bind to inflammatory targets of TTP in both endometriotic and endometrial epithelial cell lines. Our results suggest that RNABPs TTP and HuR are dysregulated in endometriotic lesions compared to matched eutopic patient samples as well endometrium from healthy controls. Silencing of TTP in endometriotic and endometrial epithelial cells revealed differential response to inflammatory cytokines and other RNABPs. Our results suggest potential involvement of HuR/TTP RNA binding protein axis in regulation of inflammation in endometriosis.
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Affiliation(s)
- Kasra Khalaj
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, K7L 3N6, Canada
| | - Soo Hyun Ahn
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, K7L 3N6, Canada
| | - Mallikarjun Bidarimath
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, K7L 3N6, Canada
| | - Yasmin Nasirzadeh
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, K7L 3N6, Canada
| | - Sukhbir S Singh
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, K1H 7W9, Canada
| | - Asgerally T Fazleabas
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University College of Human Medicine, Grand Rapids, MI, 49503, USA
| | - Steven L Young
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, NC, 27514, USA
| | - Bruce A Lessey
- Department of Obstetrics and Gynecology, Greenville Health Systems, Greenville, South Carolina, SC, 29605, USA
| | - Madhuri Koti
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, K7L 3N6, Canada.
| | - Chandrakant Tayade
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, K7L 3N6, Canada.
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Taylor HS, Giudice LC, Lessey BA, Abrao MS, Kotarski J, Archer DF, Diamond MP, Surrey E, Johnson NP, Watts NB, Gallagher JC, Simon JA, Carr BR, Dmowski WP, Leyland N, Rowan JP, Duan WR, Ng J, Schwefel B, Thomas JW, Jain RI, Chwalisz K. Treatment of Endometriosis-Associated Pain with Elagolix, an Oral GnRH Antagonist. N Engl J Med 2017; 377:28-40. [PMID: 28525302 DOI: 10.1056/nejmoa1700089] [Citation(s) in RCA: 259] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Endometriosis is a chronic, estrogen-dependent condition that causes dysmenorrhea and pelvic pain. Elagolix, an oral, nonpeptide, gonadotropin-releasing hormone (GnRH) antagonist, produced partial to nearly full estrogen suppression in previous studies. METHODS We performed two similar, double-blind, randomized, 6-month phase 3 trials (Elaris Endometriosis I and II [EM-I and EM-II]) to evaluate the effects of two doses of elagolix - 150 mg once daily (lower-dose group) and 200 mg twice daily (higher-dose group) - as compared with placebo in women with surgically diagnosed endometriosis and moderate or severe endometriosis-associated pain. The two primary efficacy end points were the proportion of women who had a clinical response with respect to dysmenorrhea and the proportion who had a clinical response with respect to nonmenstrual pelvic pain at 3 months. Each of these end points was measured as a clinically meaningful reduction in the pain score and a decreased or stable use of rescue analgesic agents, as recorded in a daily electronic diary. RESULTS A total of 872 women underwent randomization in Elaris EM-I and 817 in Elaris EM-II; of these women, 653 (74.9%) and 632 (77.4%), respectively, completed the intervention. At 3 months, a significantly greater proportion of women who received each elagolix dose met the clinical response criteria for the two primary end points than did those who received placebo. In Elaris EM-I, the percentage of women who had a clinical response with respect to dysmenorrhea was 46.4% in the lower-dose elagolix group and 75.8% in the higher-dose elagolix group, as compared with 19.6% in the placebo group; in Elaris EM-II, the corresponding percentages were 43.4% and 72.4%, as compared with 22.7% (P<0.001 for all comparisons). In Elaris EM-I, the percentage of women who had a clinical response with respect to nonmenstrual pelvic pain was 50.4% in the lower-dose elagolix group and 54.5% in the higher-dose elagolix group, as compared with 36.5% in the placebo group (P<0.001 for all comparisons); in Elaris EM-II, the corresponding percentages were 49.8% and 57.8%, as compared with 36.5% (P=0.003 and P<0.001, respectively). The responses with respect to dysmenorrhea and nonmenstrual pelvic pain were sustained at 6 months. Women who received elagolix had higher rates of hot flushes (mostly mild or moderate), higher levels of serum lipids, and greater decreases from baseline in bone mineral density than did those who received placebo; there were no adverse endometrial findings. CONCLUSIONS Both higher and lower doses of elagolix were effective in improving dysmenorrhea and nonmenstrual pelvic pain during a 6-month period in women with endometriosis-associated pain. The two doses of elagolix were associated with hypoestrogenic adverse effects. (Funded by AbbVie; Elaris EM-I and EM-II ClinicalTrials.gov numbers, NCT01620528 and NCT01931670 .).
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Affiliation(s)
- Hugh S Taylor
- From Yale School of Medicine, New Haven, CT (H.S.T.); University of California, San Francisco, San Francisco (L.C.G.); Greenville Health System, Greenville, SC (B.A.L.); University of São Paulo and Sirio Libanes Hospital, São Paulo (M.S.A.); Medical University, Lublin, Poland (J.K.); Eastern Virginia Medical School, Norfolk (D.F.A.); Augusta University, Augusta, GA (M.P.D.); Colorado Center for Reproductive Medicine, Lone Tree (E.S.); Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia (N.P.J.); Repromed Auckland, Auckland, New Zealand (N.P.J.); Mercy Health Osteoporosis and Bone Health Services, Cincinnati (N.B.W.); Creighton University School of Medicine, Omaha, NE (J.C.G.); George Washington University, Washington, DC (J.A.S.); University of Texas Southwestern Medical Center, Dallas (B.C.); Institute for the Study and Treatment of Endometriosis, Oak Brook (W.P.D.), and AbbVie, North Chicago (J.P.R., W.R.D., J.N., B.S., J.W.T., R.I.J., K.C.) - both in Illinois; and McMaster University, Hamilton, ON, Canada (N.L.)
| | - Linda C Giudice
- From Yale School of Medicine, New Haven, CT (H.S.T.); University of California, San Francisco, San Francisco (L.C.G.); Greenville Health System, Greenville, SC (B.A.L.); University of São Paulo and Sirio Libanes Hospital, São Paulo (M.S.A.); Medical University, Lublin, Poland (J.K.); Eastern Virginia Medical School, Norfolk (D.F.A.); Augusta University, Augusta, GA (M.P.D.); Colorado Center for Reproductive Medicine, Lone Tree (E.S.); Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia (N.P.J.); Repromed Auckland, Auckland, New Zealand (N.P.J.); Mercy Health Osteoporosis and Bone Health Services, Cincinnati (N.B.W.); Creighton University School of Medicine, Omaha, NE (J.C.G.); George Washington University, Washington, DC (J.A.S.); University of Texas Southwestern Medical Center, Dallas (B.C.); Institute for the Study and Treatment of Endometriosis, Oak Brook (W.P.D.), and AbbVie, North Chicago (J.P.R., W.R.D., J.N., B.S., J.W.T., R.I.J., K.C.) - both in Illinois; and McMaster University, Hamilton, ON, Canada (N.L.)
| | - Bruce A Lessey
- From Yale School of Medicine, New Haven, CT (H.S.T.); University of California, San Francisco, San Francisco (L.C.G.); Greenville Health System, Greenville, SC (B.A.L.); University of São Paulo and Sirio Libanes Hospital, São Paulo (M.S.A.); Medical University, Lublin, Poland (J.K.); Eastern Virginia Medical School, Norfolk (D.F.A.); Augusta University, Augusta, GA (M.P.D.); Colorado Center for Reproductive Medicine, Lone Tree (E.S.); Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia (N.P.J.); Repromed Auckland, Auckland, New Zealand (N.P.J.); Mercy Health Osteoporosis and Bone Health Services, Cincinnati (N.B.W.); Creighton University School of Medicine, Omaha, NE (J.C.G.); George Washington University, Washington, DC (J.A.S.); University of Texas Southwestern Medical Center, Dallas (B.C.); Institute for the Study and Treatment of Endometriosis, Oak Brook (W.P.D.), and AbbVie, North Chicago (J.P.R., W.R.D., J.N., B.S., J.W.T., R.I.J., K.C.) - both in Illinois; and McMaster University, Hamilton, ON, Canada (N.L.)
| | - Mauricio S Abrao
- From Yale School of Medicine, New Haven, CT (H.S.T.); University of California, San Francisco, San Francisco (L.C.G.); Greenville Health System, Greenville, SC (B.A.L.); University of São Paulo and Sirio Libanes Hospital, São Paulo (M.S.A.); Medical University, Lublin, Poland (J.K.); Eastern Virginia Medical School, Norfolk (D.F.A.); Augusta University, Augusta, GA (M.P.D.); Colorado Center for Reproductive Medicine, Lone Tree (E.S.); Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia (N.P.J.); Repromed Auckland, Auckland, New Zealand (N.P.J.); Mercy Health Osteoporosis and Bone Health Services, Cincinnati (N.B.W.); Creighton University School of Medicine, Omaha, NE (J.C.G.); George Washington University, Washington, DC (J.A.S.); University of Texas Southwestern Medical Center, Dallas (B.C.); Institute for the Study and Treatment of Endometriosis, Oak Brook (W.P.D.), and AbbVie, North Chicago (J.P.R., W.R.D., J.N., B.S., J.W.T., R.I.J., K.C.) - both in Illinois; and McMaster University, Hamilton, ON, Canada (N.L.)
| | - Jan Kotarski
- From Yale School of Medicine, New Haven, CT (H.S.T.); University of California, San Francisco, San Francisco (L.C.G.); Greenville Health System, Greenville, SC (B.A.L.); University of São Paulo and Sirio Libanes Hospital, São Paulo (M.S.A.); Medical University, Lublin, Poland (J.K.); Eastern Virginia Medical School, Norfolk (D.F.A.); Augusta University, Augusta, GA (M.P.D.); Colorado Center for Reproductive Medicine, Lone Tree (E.S.); Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia (N.P.J.); Repromed Auckland, Auckland, New Zealand (N.P.J.); Mercy Health Osteoporosis and Bone Health Services, Cincinnati (N.B.W.); Creighton University School of Medicine, Omaha, NE (J.C.G.); George Washington University, Washington, DC (J.A.S.); University of Texas Southwestern Medical Center, Dallas (B.C.); Institute for the Study and Treatment of Endometriosis, Oak Brook (W.P.D.), and AbbVie, North Chicago (J.P.R., W.R.D., J.N., B.S., J.W.T., R.I.J., K.C.) - both in Illinois; and McMaster University, Hamilton, ON, Canada (N.L.)
| | - David F Archer
- From Yale School of Medicine, New Haven, CT (H.S.T.); University of California, San Francisco, San Francisco (L.C.G.); Greenville Health System, Greenville, SC (B.A.L.); University of São Paulo and Sirio Libanes Hospital, São Paulo (M.S.A.); Medical University, Lublin, Poland (J.K.); Eastern Virginia Medical School, Norfolk (D.F.A.); Augusta University, Augusta, GA (M.P.D.); Colorado Center for Reproductive Medicine, Lone Tree (E.S.); Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia (N.P.J.); Repromed Auckland, Auckland, New Zealand (N.P.J.); Mercy Health Osteoporosis and Bone Health Services, Cincinnati (N.B.W.); Creighton University School of Medicine, Omaha, NE (J.C.G.); George Washington University, Washington, DC (J.A.S.); University of Texas Southwestern Medical Center, Dallas (B.C.); Institute for the Study and Treatment of Endometriosis, Oak Brook (W.P.D.), and AbbVie, North Chicago (J.P.R., W.R.D., J.N., B.S., J.W.T., R.I.J., K.C.) - both in Illinois; and McMaster University, Hamilton, ON, Canada (N.L.)
| | - Michael P Diamond
- From Yale School of Medicine, New Haven, CT (H.S.T.); University of California, San Francisco, San Francisco (L.C.G.); Greenville Health System, Greenville, SC (B.A.L.); University of São Paulo and Sirio Libanes Hospital, São Paulo (M.S.A.); Medical University, Lublin, Poland (J.K.); Eastern Virginia Medical School, Norfolk (D.F.A.); Augusta University, Augusta, GA (M.P.D.); Colorado Center for Reproductive Medicine, Lone Tree (E.S.); Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia (N.P.J.); Repromed Auckland, Auckland, New Zealand (N.P.J.); Mercy Health Osteoporosis and Bone Health Services, Cincinnati (N.B.W.); Creighton University School of Medicine, Omaha, NE (J.C.G.); George Washington University, Washington, DC (J.A.S.); University of Texas Southwestern Medical Center, Dallas (B.C.); Institute for the Study and Treatment of Endometriosis, Oak Brook (W.P.D.), and AbbVie, North Chicago (J.P.R., W.R.D., J.N., B.S., J.W.T., R.I.J., K.C.) - both in Illinois; and McMaster University, Hamilton, ON, Canada (N.L.)
| | - Eric Surrey
- From Yale School of Medicine, New Haven, CT (H.S.T.); University of California, San Francisco, San Francisco (L.C.G.); Greenville Health System, Greenville, SC (B.A.L.); University of São Paulo and Sirio Libanes Hospital, São Paulo (M.S.A.); Medical University, Lublin, Poland (J.K.); Eastern Virginia Medical School, Norfolk (D.F.A.); Augusta University, Augusta, GA (M.P.D.); Colorado Center for Reproductive Medicine, Lone Tree (E.S.); Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia (N.P.J.); Repromed Auckland, Auckland, New Zealand (N.P.J.); Mercy Health Osteoporosis and Bone Health Services, Cincinnati (N.B.W.); Creighton University School of Medicine, Omaha, NE (J.C.G.); George Washington University, Washington, DC (J.A.S.); University of Texas Southwestern Medical Center, Dallas (B.C.); Institute for the Study and Treatment of Endometriosis, Oak Brook (W.P.D.), and AbbVie, North Chicago (J.P.R., W.R.D., J.N., B.S., J.W.T., R.I.J., K.C.) - both in Illinois; and McMaster University, Hamilton, ON, Canada (N.L.)
| | - Neil P Johnson
- From Yale School of Medicine, New Haven, CT (H.S.T.); University of California, San Francisco, San Francisco (L.C.G.); Greenville Health System, Greenville, SC (B.A.L.); University of São Paulo and Sirio Libanes Hospital, São Paulo (M.S.A.); Medical University, Lublin, Poland (J.K.); Eastern Virginia Medical School, Norfolk (D.F.A.); Augusta University, Augusta, GA (M.P.D.); Colorado Center for Reproductive Medicine, Lone Tree (E.S.); Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia (N.P.J.); Repromed Auckland, Auckland, New Zealand (N.P.J.); Mercy Health Osteoporosis and Bone Health Services, Cincinnati (N.B.W.); Creighton University School of Medicine, Omaha, NE (J.C.G.); George Washington University, Washington, DC (J.A.S.); University of Texas Southwestern Medical Center, Dallas (B.C.); Institute for the Study and Treatment of Endometriosis, Oak Brook (W.P.D.), and AbbVie, North Chicago (J.P.R., W.R.D., J.N., B.S., J.W.T., R.I.J., K.C.) - both in Illinois; and McMaster University, Hamilton, ON, Canada (N.L.)
| | - Nelson B Watts
- From Yale School of Medicine, New Haven, CT (H.S.T.); University of California, San Francisco, San Francisco (L.C.G.); Greenville Health System, Greenville, SC (B.A.L.); University of São Paulo and Sirio Libanes Hospital, São Paulo (M.S.A.); Medical University, Lublin, Poland (J.K.); Eastern Virginia Medical School, Norfolk (D.F.A.); Augusta University, Augusta, GA (M.P.D.); Colorado Center for Reproductive Medicine, Lone Tree (E.S.); Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia (N.P.J.); Repromed Auckland, Auckland, New Zealand (N.P.J.); Mercy Health Osteoporosis and Bone Health Services, Cincinnati (N.B.W.); Creighton University School of Medicine, Omaha, NE (J.C.G.); George Washington University, Washington, DC (J.A.S.); University of Texas Southwestern Medical Center, Dallas (B.C.); Institute for the Study and Treatment of Endometriosis, Oak Brook (W.P.D.), and AbbVie, North Chicago (J.P.R., W.R.D., J.N., B.S., J.W.T., R.I.J., K.C.) - both in Illinois; and McMaster University, Hamilton, ON, Canada (N.L.)
| | - J Chris Gallagher
- From Yale School of Medicine, New Haven, CT (H.S.T.); University of California, San Francisco, San Francisco (L.C.G.); Greenville Health System, Greenville, SC (B.A.L.); University of São Paulo and Sirio Libanes Hospital, São Paulo (M.S.A.); Medical University, Lublin, Poland (J.K.); Eastern Virginia Medical School, Norfolk (D.F.A.); Augusta University, Augusta, GA (M.P.D.); Colorado Center for Reproductive Medicine, Lone Tree (E.S.); Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia (N.P.J.); Repromed Auckland, Auckland, New Zealand (N.P.J.); Mercy Health Osteoporosis and Bone Health Services, Cincinnati (N.B.W.); Creighton University School of Medicine, Omaha, NE (J.C.G.); George Washington University, Washington, DC (J.A.S.); University of Texas Southwestern Medical Center, Dallas (B.C.); Institute for the Study and Treatment of Endometriosis, Oak Brook (W.P.D.), and AbbVie, North Chicago (J.P.R., W.R.D., J.N., B.S., J.W.T., R.I.J., K.C.) - both in Illinois; and McMaster University, Hamilton, ON, Canada (N.L.)
| | - James A Simon
- From Yale School of Medicine, New Haven, CT (H.S.T.); University of California, San Francisco, San Francisco (L.C.G.); Greenville Health System, Greenville, SC (B.A.L.); University of São Paulo and Sirio Libanes Hospital, São Paulo (M.S.A.); Medical University, Lublin, Poland (J.K.); Eastern Virginia Medical School, Norfolk (D.F.A.); Augusta University, Augusta, GA (M.P.D.); Colorado Center for Reproductive Medicine, Lone Tree (E.S.); Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia (N.P.J.); Repromed Auckland, Auckland, New Zealand (N.P.J.); Mercy Health Osteoporosis and Bone Health Services, Cincinnati (N.B.W.); Creighton University School of Medicine, Omaha, NE (J.C.G.); George Washington University, Washington, DC (J.A.S.); University of Texas Southwestern Medical Center, Dallas (B.C.); Institute for the Study and Treatment of Endometriosis, Oak Brook (W.P.D.), and AbbVie, North Chicago (J.P.R., W.R.D., J.N., B.S., J.W.T., R.I.J., K.C.) - both in Illinois; and McMaster University, Hamilton, ON, Canada (N.L.)
| | - Bruce R Carr
- From Yale School of Medicine, New Haven, CT (H.S.T.); University of California, San Francisco, San Francisco (L.C.G.); Greenville Health System, Greenville, SC (B.A.L.); University of São Paulo and Sirio Libanes Hospital, São Paulo (M.S.A.); Medical University, Lublin, Poland (J.K.); Eastern Virginia Medical School, Norfolk (D.F.A.); Augusta University, Augusta, GA (M.P.D.); Colorado Center for Reproductive Medicine, Lone Tree (E.S.); Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia (N.P.J.); Repromed Auckland, Auckland, New Zealand (N.P.J.); Mercy Health Osteoporosis and Bone Health Services, Cincinnati (N.B.W.); Creighton University School of Medicine, Omaha, NE (J.C.G.); George Washington University, Washington, DC (J.A.S.); University of Texas Southwestern Medical Center, Dallas (B.C.); Institute for the Study and Treatment of Endometriosis, Oak Brook (W.P.D.), and AbbVie, North Chicago (J.P.R., W.R.D., J.N., B.S., J.W.T., R.I.J., K.C.) - both in Illinois; and McMaster University, Hamilton, ON, Canada (N.L.)
| | - W Paul Dmowski
- From Yale School of Medicine, New Haven, CT (H.S.T.); University of California, San Francisco, San Francisco (L.C.G.); Greenville Health System, Greenville, SC (B.A.L.); University of São Paulo and Sirio Libanes Hospital, São Paulo (M.S.A.); Medical University, Lublin, Poland (J.K.); Eastern Virginia Medical School, Norfolk (D.F.A.); Augusta University, Augusta, GA (M.P.D.); Colorado Center for Reproductive Medicine, Lone Tree (E.S.); Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia (N.P.J.); Repromed Auckland, Auckland, New Zealand (N.P.J.); Mercy Health Osteoporosis and Bone Health Services, Cincinnati (N.B.W.); Creighton University School of Medicine, Omaha, NE (J.C.G.); George Washington University, Washington, DC (J.A.S.); University of Texas Southwestern Medical Center, Dallas (B.C.); Institute for the Study and Treatment of Endometriosis, Oak Brook (W.P.D.), and AbbVie, North Chicago (J.P.R., W.R.D., J.N., B.S., J.W.T., R.I.J., K.C.) - both in Illinois; and McMaster University, Hamilton, ON, Canada (N.L.)
| | - Nicholas Leyland
- From Yale School of Medicine, New Haven, CT (H.S.T.); University of California, San Francisco, San Francisco (L.C.G.); Greenville Health System, Greenville, SC (B.A.L.); University of São Paulo and Sirio Libanes Hospital, São Paulo (M.S.A.); Medical University, Lublin, Poland (J.K.); Eastern Virginia Medical School, Norfolk (D.F.A.); Augusta University, Augusta, GA (M.P.D.); Colorado Center for Reproductive Medicine, Lone Tree (E.S.); Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia (N.P.J.); Repromed Auckland, Auckland, New Zealand (N.P.J.); Mercy Health Osteoporosis and Bone Health Services, Cincinnati (N.B.W.); Creighton University School of Medicine, Omaha, NE (J.C.G.); George Washington University, Washington, DC (J.A.S.); University of Texas Southwestern Medical Center, Dallas (B.C.); Institute for the Study and Treatment of Endometriosis, Oak Brook (W.P.D.), and AbbVie, North Chicago (J.P.R., W.R.D., J.N., B.S., J.W.T., R.I.J., K.C.) - both in Illinois; and McMaster University, Hamilton, ON, Canada (N.L.)
| | - Jean P Rowan
- From Yale School of Medicine, New Haven, CT (H.S.T.); University of California, San Francisco, San Francisco (L.C.G.); Greenville Health System, Greenville, SC (B.A.L.); University of São Paulo and Sirio Libanes Hospital, São Paulo (M.S.A.); Medical University, Lublin, Poland (J.K.); Eastern Virginia Medical School, Norfolk (D.F.A.); Augusta University, Augusta, GA (M.P.D.); Colorado Center for Reproductive Medicine, Lone Tree (E.S.); Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia (N.P.J.); Repromed Auckland, Auckland, New Zealand (N.P.J.); Mercy Health Osteoporosis and Bone Health Services, Cincinnati (N.B.W.); Creighton University School of Medicine, Omaha, NE (J.C.G.); George Washington University, Washington, DC (J.A.S.); University of Texas Southwestern Medical Center, Dallas (B.C.); Institute for the Study and Treatment of Endometriosis, Oak Brook (W.P.D.), and AbbVie, North Chicago (J.P.R., W.R.D., J.N., B.S., J.W.T., R.I.J., K.C.) - both in Illinois; and McMaster University, Hamilton, ON, Canada (N.L.)
| | - W Rachel Duan
- From Yale School of Medicine, New Haven, CT (H.S.T.); University of California, San Francisco, San Francisco (L.C.G.); Greenville Health System, Greenville, SC (B.A.L.); University of São Paulo and Sirio Libanes Hospital, São Paulo (M.S.A.); Medical University, Lublin, Poland (J.K.); Eastern Virginia Medical School, Norfolk (D.F.A.); Augusta University, Augusta, GA (M.P.D.); Colorado Center for Reproductive Medicine, Lone Tree (E.S.); Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia (N.P.J.); Repromed Auckland, Auckland, New Zealand (N.P.J.); Mercy Health Osteoporosis and Bone Health Services, Cincinnati (N.B.W.); Creighton University School of Medicine, Omaha, NE (J.C.G.); George Washington University, Washington, DC (J.A.S.); University of Texas Southwestern Medical Center, Dallas (B.C.); Institute for the Study and Treatment of Endometriosis, Oak Brook (W.P.D.), and AbbVie, North Chicago (J.P.R., W.R.D., J.N., B.S., J.W.T., R.I.J., K.C.) - both in Illinois; and McMaster University, Hamilton, ON, Canada (N.L.)
| | - Juki Ng
- From Yale School of Medicine, New Haven, CT (H.S.T.); University of California, San Francisco, San Francisco (L.C.G.); Greenville Health System, Greenville, SC (B.A.L.); University of São Paulo and Sirio Libanes Hospital, São Paulo (M.S.A.); Medical University, Lublin, Poland (J.K.); Eastern Virginia Medical School, Norfolk (D.F.A.); Augusta University, Augusta, GA (M.P.D.); Colorado Center for Reproductive Medicine, Lone Tree (E.S.); Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia (N.P.J.); Repromed Auckland, Auckland, New Zealand (N.P.J.); Mercy Health Osteoporosis and Bone Health Services, Cincinnati (N.B.W.); Creighton University School of Medicine, Omaha, NE (J.C.G.); George Washington University, Washington, DC (J.A.S.); University of Texas Southwestern Medical Center, Dallas (B.C.); Institute for the Study and Treatment of Endometriosis, Oak Brook (W.P.D.), and AbbVie, North Chicago (J.P.R., W.R.D., J.N., B.S., J.W.T., R.I.J., K.C.) - both in Illinois; and McMaster University, Hamilton, ON, Canada (N.L.)
| | - Brittany Schwefel
- From Yale School of Medicine, New Haven, CT (H.S.T.); University of California, San Francisco, San Francisco (L.C.G.); Greenville Health System, Greenville, SC (B.A.L.); University of São Paulo and Sirio Libanes Hospital, São Paulo (M.S.A.); Medical University, Lublin, Poland (J.K.); Eastern Virginia Medical School, Norfolk (D.F.A.); Augusta University, Augusta, GA (M.P.D.); Colorado Center for Reproductive Medicine, Lone Tree (E.S.); Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia (N.P.J.); Repromed Auckland, Auckland, New Zealand (N.P.J.); Mercy Health Osteoporosis and Bone Health Services, Cincinnati (N.B.W.); Creighton University School of Medicine, Omaha, NE (J.C.G.); George Washington University, Washington, DC (J.A.S.); University of Texas Southwestern Medical Center, Dallas (B.C.); Institute for the Study and Treatment of Endometriosis, Oak Brook (W.P.D.), and AbbVie, North Chicago (J.P.R., W.R.D., J.N., B.S., J.W.T., R.I.J., K.C.) - both in Illinois; and McMaster University, Hamilton, ON, Canada (N.L.)
| | - James W Thomas
- From Yale School of Medicine, New Haven, CT (H.S.T.); University of California, San Francisco, San Francisco (L.C.G.); Greenville Health System, Greenville, SC (B.A.L.); University of São Paulo and Sirio Libanes Hospital, São Paulo (M.S.A.); Medical University, Lublin, Poland (J.K.); Eastern Virginia Medical School, Norfolk (D.F.A.); Augusta University, Augusta, GA (M.P.D.); Colorado Center for Reproductive Medicine, Lone Tree (E.S.); Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia (N.P.J.); Repromed Auckland, Auckland, New Zealand (N.P.J.); Mercy Health Osteoporosis and Bone Health Services, Cincinnati (N.B.W.); Creighton University School of Medicine, Omaha, NE (J.C.G.); George Washington University, Washington, DC (J.A.S.); University of Texas Southwestern Medical Center, Dallas (B.C.); Institute for the Study and Treatment of Endometriosis, Oak Brook (W.P.D.), and AbbVie, North Chicago (J.P.R., W.R.D., J.N., B.S., J.W.T., R.I.J., K.C.) - both in Illinois; and McMaster University, Hamilton, ON, Canada (N.L.)
| | - Rita I Jain
- From Yale School of Medicine, New Haven, CT (H.S.T.); University of California, San Francisco, San Francisco (L.C.G.); Greenville Health System, Greenville, SC (B.A.L.); University of São Paulo and Sirio Libanes Hospital, São Paulo (M.S.A.); Medical University, Lublin, Poland (J.K.); Eastern Virginia Medical School, Norfolk (D.F.A.); Augusta University, Augusta, GA (M.P.D.); Colorado Center for Reproductive Medicine, Lone Tree (E.S.); Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia (N.P.J.); Repromed Auckland, Auckland, New Zealand (N.P.J.); Mercy Health Osteoporosis and Bone Health Services, Cincinnati (N.B.W.); Creighton University School of Medicine, Omaha, NE (J.C.G.); George Washington University, Washington, DC (J.A.S.); University of Texas Southwestern Medical Center, Dallas (B.C.); Institute for the Study and Treatment of Endometriosis, Oak Brook (W.P.D.), and AbbVie, North Chicago (J.P.R., W.R.D., J.N., B.S., J.W.T., R.I.J., K.C.) - both in Illinois; and McMaster University, Hamilton, ON, Canada (N.L.)
| | - Kristof Chwalisz
- From Yale School of Medicine, New Haven, CT (H.S.T.); University of California, San Francisco, San Francisco (L.C.G.); Greenville Health System, Greenville, SC (B.A.L.); University of São Paulo and Sirio Libanes Hospital, São Paulo (M.S.A.); Medical University, Lublin, Poland (J.K.); Eastern Virginia Medical School, Norfolk (D.F.A.); Augusta University, Augusta, GA (M.P.D.); Colorado Center for Reproductive Medicine, Lone Tree (E.S.); Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia (N.P.J.); Repromed Auckland, Auckland, New Zealand (N.P.J.); Mercy Health Osteoporosis and Bone Health Services, Cincinnati (N.B.W.); Creighton University School of Medicine, Omaha, NE (J.C.G.); George Washington University, Washington, DC (J.A.S.); University of Texas Southwestern Medical Center, Dallas (B.C.); Institute for the Study and Treatment of Endometriosis, Oak Brook (W.P.D.), and AbbVie, North Chicago (J.P.R., W.R.D., J.N., B.S., J.W.T., R.I.J., K.C.) - both in Illinois; and McMaster University, Hamilton, ON, Canada (N.L.)
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48
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Chang HJ, Yoo JY, Kim TH, Fazleabas AT, Young SL, Lessey BA, Jeong JW. Overexpression of Four Joint Box-1 Protein (FJX1) in Eutopic Endometrium From Women With Endometriosis. Reprod Sci 2017; 25:207-213. [PMID: 28673206 DOI: 10.1177/1933719117716780] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The four jointed box 1 (FJX1) is a regulator of angiogenesis, and the levels of FJX1 are increased in several types of cancer. Angiogenesis plays a critical role in endometrial growth as well as in several gynecologic disorders including endometriosis. However, the function of FJX1 has not been studied in endometriosis. Therefore, we examined the levels of FJX1 in eutopic endometrium from women with or without endometriosis. The levels of FJX1 protein did not change in endometrial cells during the menstrual cycle in endometrium from women without endometriosis. However, its levels were significantly higher in the secretory phase of the eutopic endometrium from women with endometriosis when compared to women without endometriosis. Hypoxia-inducible factor-1α (HIF1α) is known as a key mediator of endometriosis by regulating genes essential to estrogen production, angiogenesis, proliferation, inflammation, and extracellular invasion. It has been reported that FJX1 induces an increase in HIF1α through posttranslational stabilization. The results of our Western blot analysis reveal a significant positive correlation between FJX1 and HIF1α proteins in endometrium of women with and without endometriosis. This overexpression of FJX1 was confirmed by sequential analysis of the eutopic endometrium during endometriosis progression, using an induced model of endometriosis in the baboon. Therefore, our results suggest that high levels of FJX1 proteins may play an important role in the pathogenesis of endometriosis.
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Affiliation(s)
- Hye Jin Chang
- 1 Obstetrics, Gynecology and Reproductive Biology, Michigan State University, Grand Rapids, MI, USA.,2 Health Promotion Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jung-Yoon Yoo
- 1 Obstetrics, Gynecology and Reproductive Biology, Michigan State University, Grand Rapids, MI, USA
| | - Tae Hoon Kim
- 1 Obstetrics, Gynecology and Reproductive Biology, Michigan State University, Grand Rapids, MI, USA
| | - Asgerally T Fazleabas
- 1 Obstetrics, Gynecology and Reproductive Biology, Michigan State University, Grand Rapids, MI, USA
| | - Steven L Young
- 3 Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - Bruce A Lessey
- 4 Obstetrics and Gynecology, Greenville Health System, Greenville, SC, USA
| | - Jae-Wook Jeong
- 1 Obstetrics, Gynecology and Reproductive Biology, Michigan State University, Grand Rapids, MI, USA
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49
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Lessey BA, Kim JJ. Endometrial receptivity in the eutopic endometrium of women with endometriosis: it is affected, and let me show you why. Fertil Steril 2017; 108:19-27. [PMID: 28602477 PMCID: PMC5629018 DOI: 10.1016/j.fertnstert.2017.05.031] [Citation(s) in RCA: 155] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 05/23/2017] [Indexed: 12/14/2022]
Abstract
The endometrium maintains complex controls on proliferation and apoptosis as part of repetitive menstrual cycles that prepare the endometrium for the window of implantation and pregnancy. The reliance on inflammatory mechanisms for both implantation and menstruation creates the opportunity in the setting of endometriosis for establishment of chronic inflammation that is disruptive to endometrial receptivity, causing both infertility and abnormal bleeding. Clinically, there can be little doubt that the endometrium of women with endometriosis is less receptive to embryo implantation, and strong evidence exists to suggest that endometrial changes are associated with decreased cycle fecundity as a result of this disease. Here we provide unifying concepts regarding those changes and how they are coordinated to promote progesterone resistance and estrogen dominance through aberrant cell signaling pathways and reduced expression of key homeostatic proteins in eutopic endometrium of women with endometriosis.
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Affiliation(s)
- Bruce A Lessey
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Greenville Health System, Greenville, South Carolina.
| | - J Julie Kim
- Division of Reproductive Science in Medicine, Department of Obstetrics and Gynecology, and Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
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50
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Mendes da Silva D, Gross LA, Neto EDPG, Lessey BA, Savaris RF. The Use of Resveratrol as an Adjuvant Treatment of Pain in Endometriosis: A Randomized Clinical Trial. J Endocr Soc 2017; 1:359-369. [PMID: 29264492 PMCID: PMC5686687 DOI: 10.1210/js.2017-00053] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 03/10/2017] [Indexed: 01/19/2023] Open
Abstract
Context: Resveratrol has been used for the treatment of endometriosis. Objective: To compare resveratrol (40 mg/d) with monophasic contraceptive pill (COC) to COC with placebo for the reduction of pain scores. Design: A randomized clinical trial. Setting: University Hospital. Patients: Women (ages 20 to 50) with laparoscopic diagnosis of endometriosis were eligible for the study. Exclusion criteria: pregnancy, allergy to resveratrol, or contraindications to COC, use of agonists of gonadotropin release hormone or danazol in the last month, or had used depot medroxyprogesterone acetate or Mirena®. Intervention: Subjects were randomized using a computer-generated randomization list to receive COC for 42 days to be taken with identical capsules containing 40 mg of resveratrol or placebo in coded bottles (1:1 ratio). Allocation was concealed in coded, sequenced, opaque-sealed envelopes. Main Outcome: Median pain scores measured with a visual analog scale on day 42. Results: Between 18 June and 6 November 2015, 44 subjects were enrolled. Mean [95% confidence interval (CI)] pain scores on day 0 were 5.4 (4.2 to 6.6) in the placebo group and 5.7 (4.8 to 6.6) in resveratrol groups. After treatment, pain values were [3.9 (2.2 to 5); n = 22] and [3.2 (2.1 to 4.3); n = 22] in the placebo and resveratrol groups, respectively (P = 0.7; Mann-Whitney U test). Median (95% CI) difference between groups was 0.75 (–1.6 to 2.3). Conclusion: Resveratrol is not superior to placebo for treatment of pain in endometriosis.
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Affiliation(s)
- Daniel Mendes da Silva
- Postgraduate Program in Health Science: Gynecology and Obstetrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil, 90035-903
| | - Luiza Azevedo Gross
- Department of Obstetrics and Gynecology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil, 90035-903
| | | | - Bruce A Lessey
- Department of Obstetrics and Gynecology, Greenville Health System, Greenville, South Carolina
| | - Ricardo Francalacci Savaris
- Postgraduate Program in Health Science: Gynecology and Obstetrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil, 90035-903.,Department of Obstetrics and Gynecology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil, 90035-903
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