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Hum Immunol. 2011 May 24. [Epub ahead of print]

Association of FCRL3 -169T/C polymorphism with endometriosis and identification of a protective haplotype against the development of the disease in Brazilian population.

Bianco B, Teles JS, Lerner TG, Vilarino FL, Christofolini DM, Barbosa CP.


Division of Human Reproduction and Genetics, Department of Gynecology and Obstetrics, Faculdade de Medicina do ABC, Santo André/São Paulo, Brazil.


An aberrant immunologic mechanism has been suggested to be involved in the pathogenesis of endometriosis. Fc receptor-like 3 gene (FCRL3) has been proposed as a novel autoimmune predisposing factor. The authors have hypothesized a possible relationship between endometriosis, infertility, and FCRL3 polymorphisms. This was a case-control study that included 170 women with endometriosis-related infertility, 91 women with idiopathic infertility, and 166 controls. Detection of FCRL3 polymorphisms (-169C/T, -110G/A, +358C/G and +1381 A/G) was performed using TaqMan PCR. The results were analyzed statistically and a p value <0.05 was considered significant. Results Single-marker analysis revealed that FCRL3 -169C/T was significantly associated with endometriosis (p = 0.004), regardless of the stage of the disease, p = 0.011 and p = 0.035, respectively to minimal/mild and to moderate/severe endometriosis. No association was found considering -110A/G, +358C/G, and +1381 A/G polymorphisms either for the endometriosis-related infertility group or the idiopathic infertility group. Haplotype analysis of four FCRL3 polymorphisms identified a haplotype GGGC associated with endometriosis (p = 0.026). The haplotype AGAT was associated with protection against endometriosis (p = 0.011) and infertility (p = 0.041). The data from this study point to a possible association of the FCRL3 -169C/T polymorphisms with endometriosis, especially minimal/mild endometriosis, and the haplotype AGAT may be protective against the development of the disease, in Brazilian women. However, these findings clearly need to be replicated in an independent sample and in different populations.

Health Qual Life Outcomes. 2011 Jun 10;9:41.

Quality of life associated to chronic pelvic pain is independent of endometriosis diagnosis-a cross-sectional survey.

Souza CA, Oliveira LM, Scheffel C, Genro VK, Rosa V, Chaves MF, Cunha Filho JS.


Serviço de Ginecologia e Obstetrícia, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brasil. [email protected]




Pain is strongly related to poor quality of life. We performed a cross-sectional study in a universitary hospital to investigate quality of life in women suffering from chronic pelvic pain (CPP) due to endometriosis and others conditions.


Fifty-seven patients aged between 25 and 48 years-old submitted to laparoscopy because of CPP were evaluated for quality of life and depressive symptoms. Quality of life was accessed by a quality of life instrument [World Health Organization Quality of Life Assessment-Bref (WHOQOL-bref)]. Causes of pelvic pain were determined and severity of CPP was measured with a visual analogue scale. According to the intensity of pelvic pain score, patients were classified in two groups (group Low CPP < 25th percentile visual analogue scale and group High CPP > 25th percentile). Four dimensions on quality of life were measured (physical, psychological, social and environmental). We stratified the analysis of quality of life according CPP causes (presence or not of endometriosis in laparoscopy).


Patients with higher pain scores presented lower quality of life status in psychological and environmental dimensions. We found a negative correlation between pain scores and psychological dimension of quality of life (r = -0.310, P = .02). Quality of life scores were similar between groups with and without endometriosis (physical 54.2 ± 12.8 and 51.1 ± 13.8, P = 0.504; psychological 56.2 ± 14.4 and 62.8 ± 12.4, P = 0.182; social 55.6 ± 18.2 and 62.1 ± 19.1, P = 0.325; environmental 59.2 ± 11.7 61.2 ± 10.8, P = 0.608; respectively)


Higher pain scores are correlated to lower quality of life; however the fact of having endometriosis in addition to CPP does not have an additional impact upon the quality of life.

Hum Reprod. 2011 Aug;26(8):2157-64. Epub 2011 Jun 8.

Endometriosis expresses a molecular pattern consistent with decreased retinoid uptake, metabolism and action.

Pavone ME, Dyson M, Reirstad S, Pearson E, Ishikawa H, Cheng YH, Bulun SE.


Department of Obstetrics and Gynecology, Division of Reproductive Biology, Feinberg School of Medicine at Northwestern University, 303 Superior Street, Suite 4-123, Chicago, IL 60611, USA.


BACKGROUND Retinoic acid (RA) regulates key biological processes, including differentiation, apoptosis and cell survival. RA mediates induction of 17 beta-hydroxysteroid dehydrogenase type 2 mRNA, catalyzing the conversion of estradiol to estrone, in endometrium but not endometriosis because of a defect in endometriotic stromal cells. This defect may involve both the uptake and metabolism of RA. In this study, we analyze the expression of genes involved in RA signaling in normal endometrium and endometriosis. METHODS Tissue and stromal cells from ovarian endometriomas and eutopic endometrium from disease-free women were collected. Real-time reverse transcription-polymerase chain reaction was used to measure mRNA levels. Western blotting was used to evaluate protein expression. RESULTS We found that endometriotic tissue and stromal cells demonstrated significantly decreased mRNA expression of the major genes involved in RA signaling, including STRA6, CRBP1, ALDH1A2, CRABP2 and FABP5. We found increased levels of CYP26B1, responsible for RA metabolism. Nuclear extracts showed that RARα, RXRα and PPARβ/δ were underexpressed in both tissues and stromal cells from endometriotic tissue. Differences in protein levels were confirmed by western blotting. CONCLUSIONS Endometriosis is characterized by a gene expression pattern suggesting a decrease in uptake and metabolism of RA. Because RA is integral in regulating key biological processes involved in cell survival, this alteration could partially explain the resistance to apoptosis found in endometriosis.

Int J Immunopathol Pharmacol. 2011 Apr-Jun;24(2):481-8.

Anti-laminin-1 antibodies in sera and follicular fluid of women with endometriosis undergoing in vitro fertilization.

Caccavo D, Pellegrino NM, Totaro I, Vacca MP, Selvaggi L, Depalo R.


Department of Clinical Medicine, Immunology and Infectious Diseases, University of Bari Aldo Moro, Bari, Italy. [email protected]


There is increasing evidence that autoimmune phenomena, including auto-antibody production, may affect fertility in women with endometriosis. The aims of this study are to evaluate anti-laminin-1 antibody (aLN-1) presence in sera and in follicular fluids (FF) of women with endometriosis undergoing IVF and its impact on oocyte maturation and IVF outcome. aLN-1 were measured by a home-made enzyme linked immunosorbent assay in sera and FF obtained from 35 infertile women with endometriosis and in sera from 50 fertile controls and 27 infertile women without endometriosis (IWWE). aLN-1 serum levels were significantly higher in women with endometriosis in comparison with both fertile controls and IWWE (P<0.001 and P<0.05, respectively) and a positive correlation was found between serum- and FF-aLN-1 (r=0.47, P=0.004). According to the cut-off (mean+3 SD of fertile controls), 31% of women with endometriosis were aLN-1 positive. Metaphase II oocyte counts showed inverse correlation with FF-aLN-1 levels (r=-0.549, P=0.0006). Ongoing pregnancy (i.e pregnancy progressing beyond the 12th week of gestation) occurred in 4/11 aLN-1 positive patients and in 7/24 aLN-1 negative with no significant difference (P=0.7). In conclusion, our results highlight that aLN-1 are increased in women with endometriosis and their presence in FF may affect oocyte maturation leading to a reduced fertility. However, aLN-1 seem to have no effect on IVF outcome.

Ultrasound Obstet Gynecol. 2011 Jun 8. doi: 10.1002/uog.9072. [Epub ahead of print]

Comparison of transvaginal sonography and double-contrast barium enema for diagnosing deep infiltrating endometriosis of the posterior compartment.

Savelli L, Manuzzi L, Coe M, Mabrouk M, Donato ND, Venturoli S, Seracchioli R.


Gynecology and Reproductive Medicine Unit, Department of Obstetrics and Gynecology, S. Orsola-Malpighi Hospital, Italy. [email protected]



To compare the diagnostic accuracy of transvaginal sonography (TVS) and Double-Contrast Barium Enema (DCBE) in the pre-operative detection of Deep Infiltrating Endometriosis (DIE) of the posterior compartment.


69 consecutive patients with results of pelvic examination or symptoms suggestive for the presence of DIE of the posterior compartment were prospectively enrolled. TVS and DCBE were performed before surgery by two groups of physicians specialized in endometriosis, each blinded to the results of the other technique. Imaging data were compared to histopathologic analysis of the resected specimen taken as gold standard. The sensitivity, specificity, positive and negative predictive values and test accuracies were calculated for both imaging modalities.


women had an implant of DIE confirmed at laparoscopy and histopathologic examination.TVS diagnosed DIE in 57/67 patients (85%) while DCBE revealed the presence of the lesion in 24/67 women (36%). The sensitivity, specificity, positive and negative predictive values and accuracies for TVS and DCBE in diagnosis of posterior DIE were 85% and 36%, 100% and 100%, 17% and 4%, 85% and 38%, respectively. In patients with pure bowel DIE the corresponding features were: 91% and 43%, 100% and 100%, 100% and 100%, 28% and 6%, 91% and 45%, respectively.


Sensitivity of TVS is much higher than that of DCBE in detecting the presence of posterior DIE and should thus be regarded as the first imaging modality in the presence of a clinical suspicion. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.

Minerva Ginecol. 2011 Jun;63(3):247-59.

Innovations in conservative endometriosis treatment: an updated review.

Ruhland B, Agic A, Krampe J, Diedrich K, Hornung D.


University of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany – [email protected]


Endometriosis is a common, benign and chronic gynecological disorder. It is also an estrogen-dependent disorder that can result in intractable dysmenorrhea, heavy and/or irregular periods, painful bowel movements and urination during menstruation and infertility and ultimatively in repeated surgeries. Although surgery to remove endometriotic lesions is effective in relieving endometriosis-associated pain, recurrence rates are high and many women require continuous medical therapy to control symptoms. Symptom relief with palliation of pain and optimization of the quality of life should be the main aim of the medical therapy. Different pharmacologic treatment options are currently available. The most widely exerted medical therapy for endometriosis involves gonadotropin-releasing hormone (GnRH) agonists and oral contraceptives. Also progestogens and androgen derivates are used. New treatment options that are currently under investigation are selective progestogen receptor modulators (SPRMs), aromatase inhibitors (AI), GnRH- antagonists, cyclooxygenase (COX)-2 inhibitors, angiogenesis disruptor’s und immune modulators. Although these new agents are promising, further confirmation in randomized clinical trials is required.

J Postgrad Med. 2011 Apr-Jun;57(2):135-6.

Cecal endometriosis as an unusual cause of right iliac fossa pain.

Baraket O, Zribi R, Berriche A, Chokki A.


Department of General Surgery, Hospital of Siliana, Tunisia. [email protected]

J Obstet Gynaecol Res. 2011 Jul;37(7):683-95. doi: 10.1111/j.1447-0756.2011.01663.x. Epub 2011 Jun 9.

Aberrant DNA methylation status of endometriosis: Epigenetics as the pathogenesis, biomarker and therapeutic target.

Nasu K, Kawano Y, Tsukamoto Y, Takano M, Takai N, Li H, Furukawa Y, Abe W, Moriyama M, Narahara H.


Departments of Obstetrics and Gynecology Molecular Pathology, Faculty of Medicine, Oita University, Oita, Japan.


Endometriosis, a common, benign, estrogen-dependent disease affecting 3-10% of women of reproductive age, is characterized by the ectopic growth of endometrial tissue that is found primarily in the peritoneum, ovaries and rectovaginal septum. Recently, endometriosis has been alternatively described as an immune disease, a genetic disease and a disease caused by exposure to environmental factors, in addition to its usual description as a hormonal disease. In addition, accumulating evidence suggests that various epigenetic aberrations play definite roles in the pathogenesis of endometriosis. Epigenetic alterations reported to date in endometriosis include the genomic DNA methylation of progesterone receptor-B, E-cadherin, homeobox A10, estrogen receptor-β, steroidogenic factor-1 and aromatase. Aberrant expression of DNA methyltransferases, which attach a methyl group to the 5-carbon position of cytosine bases in the CpG island of the promoter region and silence the corresponding gene expression, has also been demonstrated in endometriosis. This review summarizes the recent studies on the aberrant DNA methylation status and aberrant expression of DNA methyltransferases, which regulate DNA methylation, in endometriosis. We also discuss the recent information on the diagnostic and therapeutic implications of epigenetic alterations occurring in endometriosis.

© 2011 The Authors. Journal of Obstetrics and Gynaecology Research © 2011 Japan Society of Obstetrics and Gynecology.

J Obstet Gynaecol Res. 2011 Jul;37(7):696-708. doi: 10.1111/j.1447-0756.2011.01655.x. Epub 2011 Jun 9.

Valproic acid alleviates generalized hyperalgesia in mice with induced adenomyosis.

Liu X, Guo SW.


Shanghai Obstetrics and Gynecology Hospital, Shanghai College of Medicine, Fudan University, Shanghai, China.


Emerging evidence suggests that adenomyosis, like endometriosisVPA, or vehicle only. Three weeks after treatment, both bodyweight and thermal response tests were evaluated again before sacrifice, and the depth of myometrial infiltration was evaluated. We found that: (i) the induction of adenomyosis resulted in progressive generalized hyperalgesia as measured by hotplate and tail-flick tests, along with decreased bodyweight; (ii) treatment with VPA, P4, or a combination was efficacious in improving generalized hyperalgesia; and (iii) drug treatment appeared to reduce the myometrial infiltration, but the difference did not reach statistical significance. Thus, VPA seems to be a promising therapeutics for treating adenomyosis, as reported recently in some case series in humans. + weeks after dosing, respectively, and then treated mice with low- and high-dose of VPA, progesterone (P4), P4 , may also be an epigenetic disease. In this study, we evaluated the effect of valproic acid (VPA) in ICR mice with adenomyosis, induced by neonatal dosing with tamoxifen. For all mice, we evaluated the bodyweight and the response to thermal stimuli by hotplate and tail-flick tests 4, 8, and 12

© 2011 The Authors. Journal of Obstetrics and Gynaecology Research © 2011 Japan Society of Obstetrics and Gynecology.

Ceska Gynekol. 2011 Apr;76(2):161-3.

Spontaneous rupture of uterine vessels during pregnancy in a patient with previous endometriosis.

[Article in Slovak]

Lajtman E, Mlyncek M, Uharcek P, Urban M.


Gynekologicko-pôrodnicka klinika Fakultnej nemocnice a Univerzity Konstantína Filozofa, Nitra. [email protected]


Spontaneous rupture of the utero-ovarian vessels during pregnancy is a rare condition that can be life-threatening. Endometriosis is one of the factors associated with this complication of the pregnancy. Location of the pain as well as the course of this complication can simulate various diseases that must be dealt with. We describe the case associated with haemoperitoneum and hemorrhagic shock.

ISRN Obstet Gynecol. 2011;2011:906138. Epub 2010 Oct 7.

Laparoscopic approach of a unicornuate uterus with noncommunicating rudimentary horns.

Medeiros LR, Rosa DD, Silva FR, Silva BR, Rosa MI.


Departament of Gynecologic Surgery, Hospital Mãe de Deus, José de Alencar 1244 apt 1009, Porto Alegre 90880-480, RS, Brazil.


Background. Müllerian duct malformations delineate a miscellaneous group of congenital anomalies that result from arrested development, abnormal formation, or incomplete fusion of the mesonephric ducts. Case. This paper describes the diagnosis and management of a noncommunicating rudimentary horn complicated by severe pelvic pain and associated endometriosis. Conclusion. This condition was diagnosed by laparoscopy and hysteroscopy examination. Operative videolaparoscopy proved to be a successful approach for the treatment of this congenital Müllerian anomaly.

Zhonghua Yi Xue Yi Chuan Xue Za Zhi. 2011 Jun;28(3):304-7.

Association of single nucleotide polymorphism in CYP17 and ERα genes with endometriosis risk in southern Chinese women.

[Article in Chinese]

Zhao X, Zong LL, Wang YF, Mao T, Fu YG, Zeng J, Rao XQ.


Department of Gynecology and Obstetrics, Zhujiang Hospital, Nanfang Medical University, Guangzhou, Guangdong, 510280 P. R. China.



To investigate the association of single nucleotide polymorphisms in cytochrome P450 17 (CYP17) and estrogen receptor alpha (ERα ) genes with the risk of endometriosis among southern Chinese women.


Two SNPs rs743572 (CYP17 gene 34T/C) and rs9322331 (ERα gene -397T/C) were genotyped by high resolution melting curve in 432 endometriosis patients and 499 matched controls.


There was no significant difference in the genotype frequencies of the two loci between endometriosis patients and the control subjects (P> 0.05). And there was no significant interaction effect of these two genes on the disease either.


CYP17 gene and ERα gene may not be genetic risk factors for endometriosis among southern women in China.

Am J Med Sci. 2011 Jun 2. [Epub ahead of print]

Deep Infiltrating Cervical Endometriosis Mimicking Rectosigmoid Cancer.

Lin PY, Cheng CJ, Lou HY, Tiong C, Fang SU, Cheng YC, Chang CC.


*Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, Taiwan, Republic of China (E-mail: [email protected]).

Hum Reprod. 2011 Aug;26(8):2028-35. Epub 2011 Jun 4.

Oral contraceptives and endometriosis: the past use of oral contraceptives for treating severe primary dysmenorrhea is associated with endometriosis, especially deep infiltrating endometriosis.

Chapron C, Souza C, Borghese B, Lafay-Pillet MC, Santulli P, Bijaoui G, Goffinet F, de Ziegler D.


Service de Gynécologie Obstétrique II and Reproductive Medicine (Professor Chapron), Université Paris Descartes, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris (AP- HP), Groupe Hospitalier Universitaire (GHU) Ouest, Centre Hospitalier Universitaire (CHU) Cochin Saint Vincent de Paul, Paris, France.


BACKGROUND The relationship between the use of oral contraception (OC) and endometriosis remains controversial. We therefore compared various characteristics of OC use and the surgical diagnosis of endometriosis histologically graded as superficial peritoneal endometriosis (SUP), ovarian endometrioma (OMA) or deep infiltrating endometriosis (DIE). METHODS This cross-sectional study included 566 patients without visible endometriosis at surgery as controls, and 410 patients with histologically proven endometriosis, categorized by their worst lesions as SUP n = 47, OMA n = 120 and DIE n = 243. Personal data, including on OC use, were prospectively collected during standardized interviews. Statistical analysis was performed using unconditional logistic regression. RESULTS Past OC users had an increased incidence of endometriosis (adjusted odd ratios (OR) = 2.79, 95% confidence interval (CI) 1.74-5.12, P = 0.002) of any revised American Fertility Society stage. Women who had previously used OC for severe primary dysmenorrhea were even more frequently diagnosed with endometriosis (adjusted OR = 5.6, 95% CI 3.2-9.8), especially for DIE (adjusted OR = 16.2, 95% CI 7.8-35.3). Women who had previously used OC for other reasons also had an increased risk of endometriosis, but to a lesser extent (adjusted OR = 2.6, 95% CI 1.8-4.1). The age at which OC was initiated, duration of OC use and free interval from last OC use were not significantly different between control and endometriosis women, irrespective of histological grading. Current OC users did not show an increased prevalence of endometriosis (OR = 1.22, 95% CI 0.6-2.52). CONCLUSIONS Our data indicate that a history of OC use for severe primary dysmenorrhea is associated with surgical diagnosis of endometriosis, especially DIE, later in life. However, this does not necessarily mean that use of OC increases the risk of developing endometriosis. Past use of OC for primary dysmenorrhea may serve as a marker for women with endometriosis and DIE.

Hum Reprod. 2011 Aug;26(8):2253-7. Epub 2011 Jun 4.

Ovarian cancer-associated polymorphisms in the BNC2 gene among women with endometriosis.

Sundqvist J, Falconer H, Seddighzadeh M, Vodolazkaia A, Fassbender A, Kyama C, Bokor A, Stephansson O, Gemzell-Danielsson K, D’Hooghe TM.


Department of Women’s and Children’s Health, Division of Obstetrics and Gynecology, Karolinska Institutet/Karolinska University Hospital, 171 76 Stockholm, Sweden.


BACKGROUND Endometriosis is a common benign gynaecological disease. Epidemiological studies have demonstrated associations between endometriosis and ovarian cancer. Recent genome-wide association studies of ovarian cancer have identified several single nucleotide polymorphisms (SNPs) in the Basonuclin 2 (BNC2) gene. In this study, we investigated these polymorphism in women with endometriosis. METHODS Six SNPs in and upstream of the BNC2 gene (rs3814113, rs4445329, rs10962656, rs12379183, rs10756819 and rs1339552) were investigated using TaqMan allelic discrimination analysis in a Caucasian population (cases: 798, controls: 351). Allelic frequencies were used as main outcome measure. RESULTS No associations were observed between the analysed SNPs and endometriosis. CONCLUSIONS Our results suggest that the analysed polymorphisms in the BNC2 gene are unlikely to contribute to the previously reported risk of ovarian cancer in women with endometriosis.

Orv Hetil. 2011 Jun 19;152(25):1013-8.


[Article in Hungarian]

Langmár Z, Sziller P.


Semmelweis Egyetem, Általános Orvostudományi Kar, II. Szülészeti és Nőgyógyászati Klinika, Budapest. [email protected]

Am J Pathol. 2011 Jun;178(6):2832-44.

Identification of cells with colony-forming activity, self-renewal capacity, and multipotency in ovarian endometriosis.

Chan RW, Ng EH, Yeung WS.


Department of Obstetrics and Gynaecology and the Center of Reproduction, Development, and Growth, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China. [email protected]


Endometriosis, the growth of endometrial tissue outside the uterine cavity, is a common gynecological disorder affecting 10% to 15% of women in their reproductive years. Retrograde menstrual shedding containing endometrial stem/progenitor cells has been postulated to be involved in its pathogenesis. In this study, we identified putative endometriotic stem/progenitor cells by their colony-forming potential, self-renewal capacity, and multipotency. Purified epithelial and stromal cells isolated from ovarian endometriotic cysts formed large and small colony-forming units (CFUs) in clonogenic assay. The colony-forming activity of epithelial and stromal cells was found to differ greatly between autologous endometrium and ovarian endometrioma samples. The large CFUs could propagate more than the small CFUs. The endometriotic epithelial small CFUs expressed epithelial markers (epithelial cell adhesion molecule, cytokeratin, and α6 integrin); only occasional large CFUs expressed α6 integrin. Aside from the expression of fibroblast markers, stromal CFUs also expressed three somatic stem cell markers: sal-like 4, CD133, and Musashi-1. Endometriotic stromal cells derived from large CFUs could differentiate into four mesenchymal lineages when cultured in the respective inducing-media, as determined by histochemical staining and RT-PCR of lineage specific markers. These findings demonstrate that ovarian endometrioma contains a subset of cells displaying somatic stem cell properties.

Eur J Obstet Gynecol Reprod Biol. 2011 Jun 1. [Epub ahead of print]

Effect of the bone marrow derived-mononuclear stem cells transplantation in the growth, VEGF-R and TNF-alpha expression of endometrial implants in Wistar rats.

Kondo W, Dal Lago EA, Francisco JC, Simeoni RB, de Noronha L, Martins AP, de Azevedo ML, Ferreira CC, Maestrelli P, Olandoski M, Guarita-Souza LC, do Amaral VF.


Department Center for Health and Biological Sciences, Pontifical Catholic University of Parana (PUC-PR), Brazil.



To study the effect of bone marrow derived-mononuclear stem cells transplantation in the growth, VEGF-R and TNF-alpha expression of surgically induced endometriosis in an experimental model.


This is an experimental study conducted in the Center for Health and Biological Sciences at the Pontifical Catholic University of Parana, Brazil. Endometriotic implants were surgically induced in 120 female Wistar rats. The animals with viable endometrial implant (larger than 25mm(2)) were randomically divided into 3 groups to receive an intraperitoneal injection of 0.2cc of saline solution (C group; n=30), a subcutaneous injection of 1mg/kg of leuprolide (L group; n=34), or an intraperitoneal injection of 5×10(6) bone marrow derived-mononuclear stem cells (SC group; n=36). They were sacrificed after 21 days to assess the implants’ size and the tissue expression of vascular endothelial growth factor receptor (VEGF-R) and tumor necrosis factor-alpha (TNF-alpha).


Treatment with leuprolide decreased the surface area of the endometriotic implant compared to the SC group and the C group. The absolute reduction in the surface area of the implant was 16.5mm, 0mm, and 0mm (p=0.007), respectively, and the percent reduction was 40.2%, 0%, and 0% (p=0.001). VEGF-R expression in the endometriotic implant decreased after treatment in the L and SC groups compared to the C group (409.6μm(2) vs. 465μm(2) vs. 920.9μm(2), respectively; p=0.021). TNF-alpha expression also reduced in the L and SC groups compared to the C group (585.7μm(2) vs. 549.3μm(2) vs. 2402.1μm(2), respectively; p<0.001).


Bone marrow derived-mononuclear stem cells transplantation decreased the expression of VEGF-R and TNF-alpha in the endometriotic implant but did not reduce the surface area of the lesion.

Fertil Steril. 2011 Jul;96(1):118-21. Epub 2011 Jun 2.

Activin-A is induced by interleukin-1β and tumor necrosis factor-α and enhances the mRNA expression of interleukin-6 and protease-activated receptor-2 and proliferation of stromal cells from endometrioma.

Yoshino O, Izumi G, Shi J, Osuga Y, Hirota Y, Hirata T, Harada M, Nishii O, Koga K, Taketani Y.


Department of Obstetrics and Gynecology, University of Tokyo, Tokyo, Japan; Department of Obstetrics and Gynecology, Mizonokuchi Hospital, Teikyo University, Kawasaki, Japan.



To examine the regulation and the function of activin-A in stromal cells derived from endometrioma.


Molecular studies.


University research laboratory.


Endometrioma stromal cells (EoSC) were obtained from 28 patients with ovarian endometrioma undergoing laparoscopy.


EoSC were cultured with inflammatory stimuli or recombinant activin-A, followed by RNA extraction.


Activin mRNA expression was evaluated by real-time reverse transcription-polymerase chain reaction (RT-PCR), and activin-A concentration of supernatant of cultured EoSC was evaluated by ELISA. Also, the effect of activin-A on EoSC was evaluated with real-time RT-PCR and cell proliferation assay.


Inflammatory stimuli, interleukin (IL) -1β, and tumor necrosis factor (TNF) -α induced inhibin/activin-βA subunit mRNA and activin-A protein expression in EoSC. Additionally, activin-A enhanced EoSC proliferation and increased the expression of IL-6 and protease-activated receptor (PAR)-2 mRNA.


An in vitro study revealed that activin-A, which is induced by IL-1β or TNF-α, might promote endometriosis by stimulating IL-6 and PAR-2 mRNA expression and increasing the proliferation of EoSC.

Fertil Steril. 2011 Jun 30;95(8):2738-2741.e3. Epub 2011 Jun 2.

Endometrial Indian hedgehog expression is decreased in women with endometriosis.

Smith K, Alnifaidy R, Wei Q, Nieman LK.


Program on Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.


Nuclear and cytoplasmic endometrial expression of Indian hedgehog increased from the late proliferative to mid and late secretory phases in 26 healthy volunteers compared with 30 women with endometriosis. The abnormal expression of Indian hedgehog protein in women with endometriosis suggests a resistance to P action.



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