J Assist Reprod Genet. 2010 Dec;27(12):701-10. Epub 2010 Sep 7.

The role of the Hoxa10/HOXA10 gene in the etiology of endometriosis and its related infertility: a review.

Zanatta A, Rocha AM, Carvalho FM, Pereira RM, Taylor HS, Motta EL, Baracat EC, Serafini PC.

Source

Huntington Medicina Reprodutiva, Av. República do Líbano, 529-Ibirapuera, 04501-000 São Paulo, SP, Brazil. alysson.zanatta@gmail.com

Abstract

PURPOSE:

endometriosis and its associated infertility have been the object of continuous research for over a century. To understand the molecular mechanisms underlying the disease, it has become necessary to determine the aspects of its etiology that are not explained by the retrograde menstruation theory. This could in turn elucidate how various clinical and surgical treatments might affect the evolution and remission of the disease.

METHODS:

this review is focused on the most recent clinical and laboratory findings regarding the association of HOXA10 with endometriosis and infertility.

RESULT:

the homebox (Hox/HOX) proteins are highly conserved transcription factors that determine segmental body identities in multiple species, including humans. Hoxa10/HOXA10 is directly involved in the embryogenesis of the uterus and embryo implantation via regulation of downstream genes. Cyclical endometrial expression of Hoxa10/HOXA10, with a peak of expression occurring during the window of implantation, is observed in the adult in response to estrogen and progesterone. Women with endometriosis do not demonstrate the expected mid-luteal rise of HOXA10 expression, which might partially explain the infertility observed in many of these patients. Recent studies also demonstrated HOXA10 expression in endometriotic foci outside the Müllerian tract.

CONCLUSIONS:

multiple lines of evidence suggest that the actions of the homeobox A10 (Hoxa10/HOXA10) gene could account for some aspects of endometriosis.

J Clin Endocrinol Metab. 2010 Dec;95(12):0.

Endometriosis.

[Article in English, Spanish]

Hormone Foundation.

J Clin Endocrinol Metab. 2010 Dec;95(12):E403-12. Epub 2010 Sep 8.

Macrophage migration inhibitory factor elicits an angiogenic phenotype in human ectopic endometrial cells and triggers the production of major angiogenic factors via CD44, CD74, and MAPK signaling pathways.

Veillat V, Carli C, Metz CN, Al-Abed Y, Naccache PH, Akoum A.

Source

Centre de recherche, Hôpital Saint-François d’Assise, and Faculty de Médecine, Université Laval, 10, rue de l’Espinay, Local D0-711, Québec (Québec), Canada G1L 3L5.

Abstract

CONTEXT:

An active angiogenesis is required for ectopic endometrial tissue growth. Our previous studies led to the identification of macrophage migration inhibitory factor (MIF), which is markedly elevated in active, vascularized, and early-stage endometriotic lesions, as a potent mitogenic factor for endothelial cells.

OBJECTIVE:

Our objective was to study the mechanisms by which MIF may stimulate angiogenesis in ectopic endometrial implantation sites.

DESIGN:

Primary cultures of ectopic endometrial cells were exposed to MIF, and the release of major angiogenic factors with targeted disruption of MIF signaling pathways was assessed.

PATIENTS:

Patients were women found to have endometriosis during laparoscopy.

SETTING:

The study was conducted at a hospital and reproduction research laboratory.

INTERVENTIONS:

Biopsies were removed from endometriotic lesions.

MAIN OUTCOME MEASURES:

Vascular endothelial cell growth factor (VEGF), IL-8, and monocyte chemotactic protein-1 (MCP-1) mRNA and protein levels and expression and small interfering RNA silencing of MIF CD74/CD44 receptor complex and phosphorylation of ERK and p38 MAPKs were evaluated.

RESULTS:

MIF markedly up-regulated VEGF, IL-8, and MCP-1 expression in endometriotic cells. Such an effect was abolished by (S,R)-3-(4-hydroxyphenyl)-4,5-dihydro-5-isoxazole acetic acid methyl ester (ISO-1), a specific inhibitor of MIF, and significantly down-regulated after specific small interfering RNA silencing of CD44 or CD74. MIF treatment strongly activated ERK and p38 MAPKs, and specific inhibitors of both pathways completely blocked basal and MIF-induced VEGF, IL-8, and MCP-1 synthesis.

CONCLUSIONS:

These results show for the first time that MIF exerts a potent indirect angiogenic effect by interacting with ectopic endometrial cells and inducing the secretion of major angiogenic factors via CD44, CD74, and MAPK signaling pathways and provide evidence for a possible new mechanism underlying endometriosis development and pathophysiology.

J Clin Endocrinol Metab. 2010 Dec;95(12):5320-9. Epub 2010 Sep 8.

MUC1 as a discriminator between endometrium from fertile and infertile patients with PCOS and endometriosis.

Margarit L, Taylor A, Roberts MH, Hopkins L, Davies C, Brenton AG, Conlan RS, Bunkheila A, Joels L, White JO, Gonzalez D.

Source

Institute of Life Science, School of Medicine, Swansea University, and Abertawe Bro Morgannwg University Trust, Singleton Hospital, Swansea SA2 8PP, Wales, United Kingdom.

Abstract

CONTEXT:

Endometrium of fertile women expresses progesterone-regulated Mucin 1 (MUC1) that carries selectin ligands recognized by the human blastocyst. Altered MUC1 expression at the time of implantation may contribute to endometrial infertility.

OBJECTIVE:

The aim was to assess the expression of MUC1 in the endometrium from polycystic ovary syndrome (PCOS), endometriosis, and fertile women in comparison with other hormone-regulated proteins [hydroxysteroid dehydrogenase (HSD) 1, HSD2, estrogen receptor (ER) and progesterone receptor (PR)].

DESIGN AND PATIENTS:

Endometrial samples were obtained from 33 fertile patients, 26 ovulatory PCOS patients, 15 anovulatory PCOS patients, and 25 endometriosis patients.

MAIN OUTCOME MEASURE:

Immunohistochemistry assessed the expression of MUC1 subunits ER, PR, HSD1, and HSD2 in endometrial epithelium. Endometrial MUC1 expression was quantified by immunoblots and RT-PCR. HSD1 and HSD2 expression was assayed by RT-PCR.

RESULTS:

MUC1ND expression was significantly higher in ovulatory PCOS than in fertile and anovulatory PCOS patients, even after progesterone stimulation. MUC1ND and -CD expression was lower in anovulatory PCOS than in fertile patients. Only MUC1CD expression was lower in endometriosis patients. Endometrial ER expression was significantly higher in PCOS and endometriosis patients, whereas PR expression was significantly higher in PCOS than in fertile patients. The expression of HSD1 was significantly higher in anovulatory PCOS than in fertile patients. Expression of HSD2 was significantly higher in PCOS patients and lower in endometriosis patients.

CONCLUSION:

Expression of MUC1 subunits in the infertile endometrium is significantly different from fertile and appears to be a component of altered gene expression that potentially contributes to endometrial insufficiency.

J Clin Endocrinol Metab. 2010 Dec;95(12):5315-9. Epub 2010 Aug 25.

Overexpression and functional relevance of somatostatin receptor-1, -2, and -5 in endometrium and endometriotic lesions.

Fasciani A, Quilici P, Biscaldi E, Flamini M, Fioravanti A, Orlandi P, Oliviero J, Repetti F, Bandelloni R, Danesi R, Simoncini T, Bocci G.

Source

Ospedali Galliera, Genova, Italy.

Abstract

CONTEXT:

Somatostatin plays a role in physiological and pathological cell proliferation and angiogenesis. Five subtypes of somatostatin receptors have been identified, and the therapeutic use of somatostatin receptor-selective agonists has been reported in several diseases.

OBJECTIVES:

The aim was to describe the expression and the functional relevance of three human somatostatin receptors (sst1, sst2, and sst5) in tissues of women with and without endometriosis.

PATIENTS AND METHODS:

This pilot study analyzed endometrium, ovarian endometriomata, and peritoneal lesions in 15 patients affected by endometriosis and the endometrium of five women without endometriosis. 111In-pentetreotide scintigraphy was used to detect endometriotic lesions; real-time RT-PCR and immunohistochemistry for sst1, sst2, and sst5 were performed. Migration and proliferation assays were performed on human endometrial stromal cells (ESC) treated with somatostatin and octreotide for 48 h.

RESULTS:

111In-pentetreotide scintigraphy was able to correctly identify and locate pelvic endometriotic lesions as confirmed by computed tomography scans. The endometrium of women with endometriosis expressed significantly more sst1, sst2, and sst5 in comparison to that of control women. Moreover, sst1, sst2, and sst5 were highly expressed in ovarian endometriomata and peritoneal lesions. The sst receptor ligand octreotide significantly inhibited ESC migration and proliferation with a maximum effect at 10(-6) m, whereas somatostatin was effective only on ESC growth.

CONCLUSIONS:

This is the first report characterizing the overexpression and functional relevance of somatostatin receptors in eutopic endometrium and lesions of patients affected by endometriosis. Thus, the use of these receptors may provide new strategies for the diagnosis and treatment of endometriosis.

J Control Release. 2010 Dec 1;148(2):226-33. Epub 2010 Sep 8.

Route of administration-dependent anti-inflammatory effect of liposomal alendronate.

Haber E, Afergan E, Epstein H, Gutman D, Koroukhov N, Ben-David M, Schachter M, Golomb G.

Source

Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Israel.

Abstract

Innate immunity and inflammation are of major importance in various pathological conditions. Intravenous (IV) and intraperitoneal (IP) liposomal alendronate (LA) treatments have been shown to deplete circulating monocytes and peritoneal macrophages resulting in the inhibition of restenosis and endometriosis (EM), respectively. Nevertheless, the correlation between the extent of circulating monocyte depletion and liposome biodistribution is unknown, and the route of administration-dependent bioactivity in restenosis and EM has not been determined. We found that, LA treatment resulted in a dose-response modified biodistribution following both IV and IP administrations. The biodistribution of high-dose LA (10mg/kg), but not that of the low-dose (1mg/kg), was similar in healthy and diseased animals. It is concluded that LA impedes its own elimination from the circulation by depleting circulating monocytes and/or inhibiting their endocytic activity, in a dose-dependent manner. Both IV and IP administration of LA mediated by the partial and transient depletion of circulating monocytes effected inhibition of restenosis. Inhibition of EM was effected only by IP administration, which depleted both intraperitoneal and circulating monocytes. Thus, EM should be considered as a local inflammatory condition with systemic manifestations as opposed to restenosis, a systemic inflammatory disease.

J Dairy Sci. 2010 Dec;93(12):5818-30.

Molecular and epidemiological characterization of bovine intrauterine Escherichia coli.

Bicalho RC, Machado VS, Bicalho ML, Gilbert RO, Teixeira AG, Caixeta LS, Pereira RV.

Source

Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA. rcb28@cornell.edu

Abstract

Escherichia coli are believed to be associated with postpartum metritis and endometritis but their role in the pathogenesis of both diseases is still undefined. In this study, uterine swabs for E. coli isolation were collected from 374 lactating Holstein cows housed on 4 commercial farms near Ithaca, New York. A total, 125 of 374 cows (33.4%) were positive for E. coli culture. Standard multiplex PCR protocols were used to screen the isolates for the presence of 32 virulence factor genes. Cows that had twin parturition were 4.4 times more likely to have intrauterine E. coli contamination than those that gave birth to single live female calves. Stillborn parturition and birth of single live male calves also increased the odds of intrauterine contamination by E. coli (3.7- and 1.6-fold, respectively) compared with birth of live female calves. Six virulence factors, common to extraintestinal and enteroaggregative E. coli, were found to be associated with metritis and endometritis: fimH, hlyA, cdt, kpsMII, ibeA, and astA. The virulence factor gene fimH was the most prevalent and the most significant: intrauterine E. coli carrying fimH and at least 1 of the other 5 identified virulence factors were pathogenic, and phylogenetic analysis based on the nucleotide sequence of DNA gyrase from 41 such IUEC revealed 2 clades.

J Hum Genet. 2010 Dec;55(12):816-21. Epub 2010 Sep 16.

Meta-analysis of genome-wide association scans for genetic susceptibility to endometriosis in Japanese population.

Adachi S, Tajima A, Quan J, Haino K, Yoshihara K, Masuzaki H, Katabuchi H, Ikuma K, Suginami H, Nishida N, Kuwano R, Okazaki Y, Kawamura Y, Sasaki T, Tokunaga K, Inoue I, Tanaka K.

Source

Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata, Japan.

Abstract

To identify susceptibility genes for endometriosis in Japanese women, genome-wide association (GWA) analysis was performed using two case-control cohorts genotyped with the Affymetrix Mapping 500K Array or Genome-Wide Human SNP Array 6.0. In each of the two array cohorts, stringent quality control (QC) filters were applied to newly obtained genotype data, together with previously analyzed data from the Japanese Integrated Database Project. After QC-based filtering of samples and single nucleotide polymorphisms (SNPs) in each cohort, 282 838 SNPs in both genotyping platforms were tested for association with endometriosis using a meta-analysis of the two GWA studies with 696 patients with endometriosis and 825 controls. The meta-analysis revealed that a common susceptibility locus conferring a large effect on the disease risk was unlikely. On the other hand, an excess of SNPs with P-values <10(-4) (36 vs 28 SNPs expected by chance) was observed in the meta-analysis. Of note, four of the top five SNPs with P-values <10(-5) were located in and around IL1A (interleukin 1α), which might be a functional candidate gene for endometriosis. Further studies with larger case-control cohorts will be necessary to elucidate the genetic risk factors.

J Obstet Gynaecol Res. 2010 Dec;36(6):1214-21. doi: 10.1111/j.1447-0756.2010.01345.x.

Improved nude mouse models for green fluorescence human endometriosis.

Liu B, Wang NN, Wang ZL, Hong SS, Li JT, Ding HJ, Pan QH, Dong Y, Zhou CQ, Zhuang GL.

Source

Department of Obstetrics and Gynecology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou,China.

Abstract

AIM:

To establish an improved noninvasive fluorescent animal model for endometriosis.

MATERIAL AND METHODS:

Adenovirus encoding enhanced green fluorescent protein (Ad-eGFP) was used to transfect primary culture endometrial glandular cells and stromal cells (purified cell transfection and mixed injection, Group 1) as well as endometrial fragments (tissues transfection and injection, Group 2). Transfection results were compared between the cells and tissues in vitro. The GFP-transfected cells suspension of Group 1 or endometrial fragments of Group 2, with similar weight, were injected into nude mice subcutaneously and noninvasively observed every 5 days until day 15 (Subgroup 1, N = 5), day 20 (Subgroup 2, N = 5) or day 25 (Subgroup 3, N =11). The positive rates and duration times of the fluorescent lesions were calculated.

RESULTS:

After 18 h of incubation, glandular cells and stromal cells all had higher GFP-positive rates. In vivo imaging showed that the GFP positive rates of Group 1 were significantly higher than those of Group 2. The fluorescent-positive durations of Groups 1 and 2 were 23.636 ± 4.523 days and 5.909 ± 5.394 days, respectively (P < 0.001). In vivo analysis demonstrated that on days 15, 20, and 25, there were more typical lesions and fluorescent-positive lesions formed in Group 1 and that the lesion weight in Group 1 was greater. The structures of the lesions were all identified as human origin.

CONCLUSION:

A noninvasive animal model for endometriosis created by subcutaneous injection of an Ad-eGFP-transfected endometrial glandular and stromal cells suspension had higher a positive rate, longer duration time of fluorescent imaging and greater lesion weight.

J Pediatr Adolesc Gynecol. 2010 Dec;23(6 Suppl):S15-21.

Overview of bleeding disorders in adolescent females with menorrhagia.

Ahuja SP, Hertweck SP.

Source

Case Western Reserve University, Cleveland, Ohio, USA. sanjay.ahuja@case.edu

Abstract

Women bleed with menses, during childbirth, and after childbirth. Women are more likely to manifest a bleeding disorder as they have more opportunities to experience bleeding challenges in their lifetime. Bleeding disorders such as hemophilia and von Willebrand disease affect 2.5-3 million American women. The most common inherited bleeding disorder in the population is von Willebrand disease with an estimated prevalence of 1-2%. von Willebrand factor (vWF) is required to adhere platelets to exposed subendothelium and protects factor VIII from proteolysis in the circulation. The prevalence of vWF rises in studies involving women with menorrhagia, with estimates ranging as high as 10-20% in white women, and 1-2% among African American women. Other bleeding disorders seen in adolescents with menorrhagia are disorders of inherited platelet dysfunction, clotting factor deficiencies, thrombocytopenia, and disorders of the fibrinolytic pathway. Not only are women more likely to present early in their life with a bleeding disorder, they are also more likely to have other gynecologic manifestations as a result of these disorders. This article presents an overview of the problem and touches upon the different management strategies available.

 

Kyobu Geka. 2010 Dec;63(13):1181-3.

Catamenial pneumothorax; report of a case.

[Article in Japanese]

Hokka D, Yoshikawa K, Morimoto M, Kamimura R, Tane K, Hoshida Y.

Source

Department of Thoracic Surgery, Sumitomo Hospital, Osaka, Japan.

Abstract

A 39-year-old woman was referred to our hospital because of pneumothorax related to menstruation. Chest X-ray showed right pneumothorax. Right thoracoscopy revealed 3 fenestrations on the diaphragm. Partial resection of the diaphragm including these lesions were performed. Intrathoracic minocycline was applied expecting pleural adhesion after surgery. Histopathological examination confirmed the presence of endometriosis on the resected diaphragm.

Pain. 2010 Dec;151(3):703-10. Epub 2010 Sep 15.

Endocannabinoid involvement in endometriosis.

Dmitrieva N, Nagabukuro H, Resuehr D, Zhang G, McAllister SL, McGinty KA, Mackie K, Berkley KJ.

Source

Program in Neuroscience, Florida State University, Tallahassee, FL32306-4301, USA.

Abstract

Endometriosis is a disease common in women that is defined by abnormal extrauteral growths of uterine endometrial tissue and associated with severe pain. Partly because how the abnormal growths become associated with pain is poorly understood, the pain is difficult to alleviate without resorting to hormones or surgery, which often produce intolerable side effects or fail to help. Recent studies in a rat model and women showed that sensory and sympathetic nerve fibers sprout branches to innervate the abnormal growths. This situation, together with knowledge that the endocannabinoid system is involved in uterine function and dysfunction and that exogenous cannabinoids were once used to alleviate endometriosis-associated pain, suggests that the endocannabinoid system is involved in both endometriosis and its associated pain. Herein, using a rat model, we found that CB1 cannabinoid receptors are expressed on both the somata and fibers of both the sensory and sympathetic neurons that innervate endometriosis’s abnormal growths. We further found that CB1 receptor agonists decrease, whereas CB1 receptor antagonists increase, endometriosis-associated hyperalgesia. Together these findings suggest that the endocannabinoid system contributes to mechanisms underlying both the peripheral innervation of the abnormal growths and the pain associated with endometriosis, thereby providing a novel approach for the development of badly-needed new treatments.

Photomed Laser Surg. 2010 Dec;28(6):735-40. Epub 2010 Oct 22.

Studies on function of P-glycoprotein in photodynamic therapy of endometriosis.

Wołuń-Cholewa M, Szymanowski K, Andrusiewicz M, Warchoł W.

Source

Department of Cell Biology, Poznan University of Medical Sciences, Poznań, Poland. doskon@amp.edu.pl

Abstract

OBJECTIVE:

The aim of the present study was to examine whether the effects of endometriosis-targeted photodynamic therapy (PDT), dependent on 5-aminolevulinic acid (ALA), rely on the presence of P-glycoprotein (P-gp), which is regarded as constituting one of the causes of multidrug resistance phenomenon.

BACKGROUND:

The significance of the undertaken studies reflects the complete absence of reports related to the modulation of P-gp activity and efficacy of PDT in patients with endometriosis.

MATERIALS AND METHODS:

Tissue samples of normal endometria were obtained from eight women after hysterectomy who were diagnosed with cervical intra-epithelial neoplasia. Fragments of ovarian endometriosis were obtained from 15 women. Epithelial cells were isolated from the material and in in vitro conditions were preincubated with P-gp blocker-verapamil-before ALA-PDT. The cytotoxicity was evaluated using the XTT test, allowing us to estimate cell growth inhibition. Statistical analysis of the results involved the nonparametric Wilcoxon paired rank test and the Mann-Whitney U-test using the Statistica v5 software (p < 0.05). In parallel, P-gp presence in the analyzed material was evaluated using immunohistochemistry.

RESULTS:

In normal endometrial epithelium, verapamil was shown to intensify phototoxic effects at 2 and 4 mmol/L ALA (p < 0.05). In endometriotic epithelium, such intensification was noted in all examined concentrations of ALA (p < 0.001). Moreover, the ectopic epithelial cells were more sensitive than eutopic epithelial cells to PDT upon ALA alone, as well as after preincubation with verapamil. Immunohistohemical analysis allowed us to demonstrate the absence of glycoprotein P in normal endometrium. In endometriosis, P-gp was localised in both the epithelium and the stroma of the examined material.

CONCLUSION:

Phototoxic effects could be amplified in epithelial cells of endometriotic foci by appropriate action of verapamil and 5-aminolevulinic acid.

Radiol Med. 2010 Dec;115(8):1330-9. Epub 2010 Sep 17.

Ultrasound-guided aspiration and ethanol sclerotherapy for treating endometrial cysts.

[Article in English, Italian]

Gatta G, Parlato V, Di Grezia G, Porto A, Cappabianca S, Grassi R, Rotondo A.

Source

Dipartimento di Internistica Clinica e Sperimentale Magrassi-Lanzara, Sezione di Radiodiagnostica e Radioterapia, Seconda Università degli Studi di Napoli, Piazza Miraglia 2, Naples, Italy.

Abstract

PURPOSE:

The authors sought to evaluate the effectiveness of ultrasound (US)-guided aspiration and ethanol sclerotherapy in treating endometrial cysts and adopt this procedure as an alternative to surgery.

MATERIALS AND METHODS:

Fifty consecutive patients with an average age of 25.2 years [standard deviation (SD) 6.5; range 16-40 years) and US diagnosis of endometrial cyst who were pregnant or presenting with high anaesthesia risk, adhesions or who refused surgery underwent US-guided aspiration of a total of 54 endometrial cysts (40 with transabdominal approach and the remaining 14 with transvaginal approach) and ethanol sclerotherapy.

RESULTS:

The procedure was successful in all patients. Follow-up imaging was carried out at 12 h, 24 h, 15 days, 3 months, 6 months and 12 months. After 12 months, four patients (8%) showed recurrence, three of whom opted for a second session of US-guided aspiration and ethanol sclerotherapy.

CONCLUSIONS:

US-guided aspiration and sclerotherapy with 95% ethanol provides a valid alternative to surgery in treating endometrial cysts.

Reprod Sci. 2010 Dec;17(12):1099-111. Epub 2010 Oct 5.

Generalized hyperalgesia in women with endometriosis and its resolution following a successful surgery.

He W, Liu X, Zhang Y, Guo SW.

Source

Shanghai OB/GYN Hospital, Fudan University, Shanghai, China.

Abstract

Although pains of various kinds top the list of complaints from women with endometriosis and are the most debilitating of the disease, little is known about the mechanism/mechanisms of endometriosis-associated pains. To test the hypothesis that women with endometriosis have generalized hyperalgesia which may be alleviated by a successful surgery, we recruited 100 patients with surgically and histologically confirmed endometriosis and 70 women without, and tested their responses to pain stimulations. Before the surgery, all patients rated their dysmenorrhea severity by Visual Analog scale (VAS) and went through an ischemic pain test (IPT) and an electrical pain test (EPT). The controls were also administrated with IPT/EPT. Three and 6 months after surgery, all patients were administrated with IPT/EPT and rated their severity of dysmenorrhea. We found that patients with endometriosis had significantly higher IPT VAS scores and lower EPT pain threshold than controls, but after surgery their IPT scores and EPT pain threshold were significantly and progressively improved, along with their dysmenorrhea severity. Thus, we conclude that women with endometriosis have generalized hyperalgesia, which was alleviated by surgery. Consequently, central sensitization may be a possible mechanism underlying various forms of pain associated with endometriosis, and its recognition should have important implications for the development of novel therapeutics and better clinical management of endometriosis.

Reproduction. 2010 Dec;140(6):911-20. Epub 2010 Sep 14.

Extracellular matrix metalloproteinase inducer expression in the baboon endometrium: menstrual cycle and endometriosis.

Braundmeier AG, Fazleabas AT, Nowak RA.

Source

Department of Animal Sciences, University of Illinois, 1207 West Gregory Drive, Urbana, Illinois 61801, USA.

Abstract

Extracellular matrix metalloproteinase inducer (EMMPRIN; BSG) regulates tissue remodeling through matrix metalloproteinases (MMPs). In human and non-human primates, endometrial remodeling is important for menstruation and the pathogenesis of endometriosis. We hypothesized that as in humans, BSG and MMPs are expressed in the endometrium of cycling baboons, and their expression is hormonally regulated by ovarian hormones, but endometriosis disrupts this regulation. BSG expression was evaluated in the baboon endometrium by q-PCR and immunohistochemistry. In the endometrium of control cycling animals, BSG mRNA levels were highest in late secretory stage tissue. BSG protein localized to glandular epithelial cells during the proliferative phase; whereas, secretory stage tissues expressed BSG in glandular and luminal epithelia with weak stromal staining. Several MMPs were differentially expressed throughout the menstrual cycle with the highest levels found during menstruation. In ovariectomized animals, BSG endometrial mRNA levels were highest with treatment of both estrogen and progesterone than that with only estrogen. Estrogen alone resulted in BSG protein localization primarily in the endometrial glandular epithelia, while estrogen and progesterone treatment displayed BSG protein localization in both the glandular and stromal cells. Exogenous hormone treatment resulted in differential expression patterns of all MMPs compared with the control cycling animals. In the eutopic endometrium of endometriotic animals, BSG mRNA levels and protein were elevated early but decreased later in disease progression. Endometriosis elevated the expression of all MMPs except MMP7 compared with the control animals. In baboons, BSG and MMP endometrial expression is regulated by both ovarian hormones, and their expression patterns are dysregulated in endometriotic animals.

Surg Endosc. 2010 Dec;24(12):3060-7. Epub 2010 Jun 8.

Laparoscopic versus laparotomic radical en bloc hysterectomy and colorectal resection for endometriosis.

Daraï E, Ballester M, Chereau E, Coutant C, Rouzier R, Wafo E.

Source

Department of Gynecology and Obstetrics, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, CancerEst, Université Pierre et Marie Curie, Paris 6, France. emile.darai@tnn.aphp.fr

Abstract

BACKGROUND:

Radical en bloc hysterectomy and colorectal resection (REHCR) is the ultimate and radical surgery for extensive pelvic endometriosis. Our aims were to evaluate feasibility, quality of life, and urinary function after REHCR by laparoscopy compared with laparotomy.

METHODS:

Single-center, retrospective study of 29 endometriosis patients having undergone REHCR (16 by laparoscopy, 13 by laparotomy). Gynecologic and digestive symptoms, quality of life [Short-Form (SF)-36 health status], and urinary function [International Prostate Score Symptoms (IPSS) and Bristol Female Lower Urinary Tract Symptoms (BFLUTS)] were evaluated using validated questionnaires.

RESULTS:

Except for mean age, no difference in epidemiologic characteristics was found between groups. Mean follow-up was 14 months (range 1-78 months). Four of the 16 patients (25%) of the laparoscopic group required laparoconversion. Consumption of analgesic drugs was lower in the laparoscopic group, and diarrhea (P < 0.001) and lower back pain (P < 0.001) improved. Improvement in dysmenorrhea (P < 0.001), dyspareunia (P < 0.001), asthenia (P < 0.001), and quality of life was observed without difference between groups. Urinary function was not altered and did not differ between groups.

CONCLUSION:

Our data support the feasibility of REHCR by laparoscopy with less analgesic consumption. Efficacy in terms of symptoms and improvement in quality of life were similar between groups, suggesting that laparoscopy should be offered to patients requiring REHCR.

Urologe A. 2010 Dec;49(12):1522-4, 1526.

Cyst, endometriosis, borderline tumor, CUP : diagnostic stations of a supposedly simple renal cyst.

[Article in German]

Elert A, Forst F, Ihling C, Schneider A.

Source

Klinik für Urologie und Kinderurologie, Main-Kinzig-Kliniken gGmbH, Herzbachweg 14, 63571, Gelnhausen, Deutschland. achim.elert@mkkliniken.de

Abstract

Symptomatic renal cysts are not uncommon and can be treated by puncture, sclerotherapy, or laparoscopic fenestration. We report the case of a female patient in whom the diagnosis of a supposedly simple symptomatic renal cyst changed over endometriosis and borderline malignancy to a CUP. This case shows that in spite of all diagnostic measures and care the final diagnosis can be a surprise.

Zhonghua Yi Xue Yi Chuan Xue Za Zhi. 2010 Dec;27(6):692-6.

Association of the CYP19 gene polymorphism with genetic susceptibility to endometriosis.

[Article in Chinese]

Yang X, Chen SQ, Liu M.

Source

Department of Obstetrics and Gynecology, the Second Affiliated Hospital, Hebei Medical University, Shijiazhuang, Hebei, P.R. China.

Abstract

OBJECTIVE:

To investigate whether the 115T/C, 240A/G and 1531C/T polymorphisms of CYP19 gene are associated with the risk of moderate/severe endometriosis.

METHODS:

Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique was used to identify the CYP19 gene polymorphism in Chinese patients with endometriosis of III-IV stage (n= 102) and individuals without endometriosis (n= 100).

RESULTS:

The frequencies of CYP19 gene 115T/C, TT, TC and CC were 0.9118, 0.0882 and 0 in the endometriosis group, and 0.8800, 0.1100 and 0.0100 in the control group, respectively. The frequencies of 115T and C alleles in both groups were 0.9559 and 0.0441, and 0.9350 and 0.0650, respectively (P> 0.05). The frequencies of CYP19 gene 240AA, AG and GG were 0.2745, 0.4902 and 0.2353 in the endometriosis group, and 0.4500, 0.4100 and 0.1400 in the control group, respectively. The frequencies of 240A and G alleles in both groups were 0.5196 and 0.4804, and 0.6550 and 0.3450, respectively (P< 0.05). The frequencies of CYP19 gene 1531C/T, CC, CT and TT were 0.4118, 0.4706 and 0.1176 in the endometriosis group, and 0.3800, 0.4200 and 0.200 in the control group, respectively. The frequencies of 1531C and T alleles in both groups were 0.6471 and 0.3529, and 0.5900 and 0.4100, respectively (P> 0.05).

CONCLUSION:

CYP19 gene 240G/G polymorphism may contribute to the susceptibility of stages III and IV endometriosis but there was no association between CYP19 gene 115T/C and 1531C/T polymorphisms and stage III and IV endometriosis.

Clin Evid (Online). 2010 Nov 11;2010. pii: 0819.

Female infertility.

Bhattacharya S, Johnson N, Tijani HA, Hart R, Pandey S, Gibreel AF.

Source

Obstetrics & Gynaecology, Aberdeen Maternity Hospital, Aberdeen, UK.

Abstract

INTRODUCTION:

About 17% of couples in industrialised countries seek help for infertility, which may be caused by ovulatory failure, tubal damage or endometriosis, or a low sperm count. In developed countries, 80% to 90% of couples attempting to conceive are successful after 1 year and 95% after 2 years. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for infertility caused by ovulation disorders? What are the effects of treatments for tubal infertility? What are the effects of treatments for infertility associated with endometriosis? What are the effects of treatments for unexplained infertility? We searched: Medline, Embase, The Cochrane Library, and other important databases up to October 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).

RESULTS:

We found 55 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.

CONCLUSIONS:

In this systematic review we present information relating to the effectiveness and safety of the following interventions: clomifene; drug-induced ovarian suppression; gonadotrophin priming of oocytes before in vitro maturation; gonadotrophins; gonadotrophin-releasing hormone agonists plus gonadotrophins; gonadotrophin-releasing hormone antagonists; in vitro fertilisation; intrauterine insemination alone, or combined with gonadotrophins or clomifene; laparoscopic ablation of endometrial deposits; laparoscopic ovarian drilling; laparoscopic removal; metformin; ovarian wedge biopsy; pulsatile gonadotrophin-releasing hormone; selective salpingography plus tubal catheterisation; tamoxifen; tubal flushing; and tubal surgery before in vitro fertilisation.

 

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