Modern view on the diagnostics and treatment of adenomyosis

Analysis of dysmenorrhea-related factors in adenomyosis and development of a risk prediction model

OBJECTIVE

To explore factors related to dysmenorrhea in adenomyosis and construct a risk prediction model.

METHODS

A cross-sectional survey involving 1636 adenomyosis patients from 37 hospitals nationwide (November 2019-February 2022) was conducted. Data on demographics, disease history, menstrual and reproductive history, and treatment history was collected.Patients were categorized into dysmenorrhea and non-dysmenorrhea groups. Multivariate logistic regression analyzed factors influencing dysmenorrhea, and a risk prediction model was created using a nomogram. The model's performance was evaluated through ROC curve analysis, C-index, Hosmer-Lemeshow test, and bootstrap method The nomogram function was used to establish a nomogram model. The model was evaluated using the area under the ROC curve (AUC), C-index, Hosmer-Lemeshow goodness-of-fit test, and bootstrap method. Patients were scored based on the nomogram, and high-risk groups were delineated.

RESULTS

Dysmenorrhea was present in 61.31% (1003/1636) of the patients. Univariate analysis showed significant differences (P < 0.05) between groups in age at onset, course of disease, oligomenorrhea, menorrhagia, number of deliveries, pelvic inflammatory disease, family history of adenomyosis, exercise, and excessive menstrual fatigue. Significant factors included menorrhagia, multiple deliveries, pelvic inflammatory disease, and family history of adenomyosis as risk factors. Older age at onset, oligomenorrhea, and exercise were identified as protective factors. The model's accuracy, discrimination, and reliability were acceptable, and a risk score > 88.5 points indicated a high-risk group.

CONCLUSION

Dysmenorrhea is prevalent among adenomyosis patients. Identifying and mitigating risk factors, while leveraging protective factors, can aid in prevention and management. The developed model effectively predicts dysmenorrhea risk, facilitating early intervention and treatment.

Exosomal miR-92a-3p serves as a promising marker and potential therapeutic target for adenomyosis

This study aimed to elucidate the role of microRNA-92a-3p (miR-92a-3p) in the pathogenesis of adenomyosis. We examined how miR-92a-3p, found in exosomes derived from ectopic lesions, influences the behaviour of endometrial cells, dorsal root ganglion (DRG), and human umbilical vein endothelial cells (HUVECs) and explored its potential as a non-invasive biomarker. Our findings revealed that miR-92a-3p was significantly upregulated in exosomes derived from ectopic adenomyotic lesions. This upregulation correlated with enhanced migration and invasion of eutopic endometrial cells, DRG, and HUVECs. Furthermore, this study demonstrated a significant correlation between miR-92a-3p levels in urinary exosomes and the clinical symptoms of adenomyosis, suggesting its potential as a non-invasive biomarker for the disease. This study elucidated an exosomal signalling process involving miR-92a-3p that drives pathological infiltration and angiogenesis to promote adenomyosis progression. Our findings highlight upregulated miR-92a-3p in biofluid exosomes as a promising non-invasive biomarker for diagnosing and monitoring adenomyosis and unveil novel targets and strategies for improved clinical management.

Mapping Human Uterine Disorders Through Single-Cell Transcriptomics

Disruptions in uterine tissue function contribute to disorders such as endometriosis, adenomyosis, endometrial cancer, and fibroids, which all significantly impact health and fertility. Advances in transcriptomics, particularly single-cell RNA sequencing, have revolutionized uterine biological research by revealing the cellular heterogeneity and molecular mechanisms underlying disease states. Single-cell RNA sequencing and spatial transcriptomics have mapped endometrial and myometrial cellular landscapes, which helped to identify critical cell types, signaling pathways, and phase-specific dynamics. Said transcriptomic technologies also identified stromal and immune cell dysfunctions, such as fibroblast-to-myofibroblast transitions and impaired macrophage activity, which drive fibrosis, chronic inflammation, and lesion persistence in endometriosis. For endometrial cancer, scRNA-seq uncovered tumor microenvironmental complexities, identifying cancer-associated fibroblast subtypes and immune cell profiles contributing to progression and therapeutic resistance. Similarly, studies on adenomyosis highlighted disrupted signaling pathways, including Wnt and VEGF, and novel progenitor cell populations linked to tissue invasion and neuroinflammation, while single-cell approaches characterized smooth muscle and fibroblast subpopulations in uterine fibroids, elucidating their roles in extracellular matrix remodeling and signaling pathways like ERK and mTOR. Despite challenges such as scalability and reproducibility, single-cell transcriptomic approaches may have potential applications in biomarker discovery, therapeutic target identification, and personalized medicine in gynecological disorders.

Recurrence rates and associated risk factors after conservative surgery for adenomyosis: a retrospective study

BACKGROUND

Conservative surgery for adenomyosis has been shown to be effective. However, risk factors for postoperative recurrence have yet to be clarified. In this study, we aimed to determine the recurrence rate after conservative surgery for adenomyosis and identify the risk factors for recurrence.

METHODS

This retrospective study was conducted in a tertiary hospital. Patients who underwent conservative surgery for adenomyosis between January 2013 and April 2023 were identified. Eligible patients were assigned to either the recurrent or non-recurrent group. Continuous and categorical variables were compared between the two groups using the Mann-Whitney U test or chi-squared test. Risk factors for recurrence were identified by Cox proportional risk analysis.

RESULTS

Data for 133 eligible patients who underwent conservative surgery for adenomyosis were analyzed. The mean follow-up duration was 52 months. The recurrence rate after conservative surgery was 39.1% (52/133). Cox proportional risk analysis identified adenomyosis involving the posterior uterine wall (hazard ratio [HR] 6.505, P = 0.018), two or more adenomyotic lesions (HR 6.310, P = 0.030), laparotomy (HR 2.490, P = 0.029), and concomitant endometriosis (HR 2.313, P = 0.036) to be risk factors for recurrence after conservative surgery. Postoperative combined progestogen therapy (HR 0.126, P < 0.001) or treatment with a gonadotropin-releasing hormone agonist (GnRHa) (HR 0.237, P = 0.004) prevented recurrence of adenomyosis.

CONCLUSION

Adenomyosis continues to have a relatively high long-term recurrence rate after conservative surgery. Patients with adenomyosis involving the posterior wall of the uterus, those with two or more adenomyotic lesions, and those with concomitant endometriosis are at high risk for recurrence after conservative surgery. Postoperative progestogen or GnRHa therapy may reduce the risk of recurrence of adenomyosis. Considering the retrospective nature of this study and its small sample size, larger prospective studies are needed to confirm its findings.

Macrophage polarization in adenomyosis: A review

Adenomyosis (AM) is a common gynecological disorder characterized by the presence of endometrial glands and stroma within the uterine myometrium. It is associated with abnormal uterine bleeding (AUB), dysmenorrhea, and infertility. Although several mechanisms have been proposed to elucidate AM, the exact cause and development of the condition remain unclear. Recent studies have highlighted the significance of macrophage polarization in the microenvironment, which plays a crucial role in AM initiation and progression. However, a comprehensive review regarding the role and regulatory mechanism of macrophage polarization in AM is currently lacking. Therefore, this review aims to summarize the phenotype and function of macrophage polarization and the phenomenon of the polarization of adenomyosis-associated macrophages (AAMs). It also elaborates on the role and regulatory mechanism of AAM polarization in invasion/migration, fibrosis, angiogenesis, dysmenorrhea, and infertility. Furthermore, this review explores the underlying molecular mechanisms of AAM polarization and suggests future research directions. In conclusion, this review provides a new perspective on understanding the pathogenesis of AM and provides a theoretical foundation for developing targeted drugs through the regulation of AAM polarization.

Role of Pink1-mediated mitophagy in adenomyosis

Abstract Background

Recent studies indicate that endometrial hypoxia plays a critical role in adenomyosis (AM) development. Mitochondria are extremely sensitive to hypoxic damage, which can result in both morphological and functional impairment. Mitophagy is a crucial mechanism for preserving mitochondrial quality by selectively removing damaged mitochondria, thus ensuring the proper functioning of the entire mitochondrial network. In response to hypoxia, PINK1 is activated as a regulator of mitophagy, but its role in AM requires further study.

Objective

To explore the potential mechanism of mitophagy mediated by PINK1 in the pathogenesis of AM.

Method

The study compared PINK1, Parkin, OPTIN, P62, and NDP52 protein expression levels in patients with or without AM using clinical specimens and an AM mouse model. Pathological changes were compared using HE staining. Immunofluorescence and western blot were used to detect protein expression levels. Endometrial stromal cells (ESC) were isolated and examined for mitophagy, protein expression level, and cell invasion ability.

Results

Both the endometrial tissue from patients with AM and AM ESC displayed an upregulation of protein levels for PINK1, Parkin, OPTIN, P62, and NDP52 when compared with the control group. Then, HE staining confirmed the successful establishment of the AM mouse model. Moreover, the ultrastructural analysis using transmission electron microscopy revealed that AM mice's endometrial glandular epithelial and stromal cells had exhibited swollen, deformed, and reduced mitochondria along with an increase in the number of lysosomes and mitochondrial autophagosomes. The protein levels of PINK1, Parkin, OPTIN, P62, and NDP52 in uterine tissue from AM mice were noticeably increased, accompanied by a considerable upregulation of ROS levels compared to the control group. In addition, cells in the AM group showed remarkably elevated mitophagy and invasion potentials compared to the control group. In contrast, the cell invasion ability decreased following PINK1 knockdown using the RNA interference technique.

Conclusion

The high levels of PINK1-mediated mitophagy have been found in AM. The upregulation in mitophagy contributes to mitochondrial damage, which may result in the abnormal invasion characteristic of AM.