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The Impact of Androgen Receptor Expression on Endometrial Carcinoma Recurrence and Survival. Int J Gynecol Pathol 2018; 36:405-411. [PMID: 28277313 DOI: 10.1097/pgp.0000000000000355] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Endometrial carcinomas (ECs) are the most common gynecologic cancers in the western world. The impact of androgen receptor (AR) on clinicopathologic parameters of EC is not well studied. The aim of our study is to assess the role of AR expression in ECs and correlate its expression with estrogen (ER) and progesterone (PR). A retrospective review of 261 EC was conducted. H&E slides were reviewed and clinicopathologic parameters were analyzed. Immunohistochemical stains for AR, ER, and PR were performed on a tissue microarray. The hormonal expression was evaluated and the data were analyzed using the Fisher exact test and Kaplan-Meier survival analysis. Patients' age ranged from 31 to 91 (median=65 y). Type I EC included 202 endometrioid and 7 mucinous carcinoma, whereas type II included 34 serous, 16 carcinosarcoma, and 2 clear cell carcinoma. Although not significant, AR expression showed more frequent association with type I EC, early tumor stage (I-II), and low FIGO grade (1-2) EC. AR expression significantly correlated with absence of lymphovascular invasion (P=0.041) and decreased LN involvement (P=0.048). Patients with AR expression showed increased disease-free survival (208 vs. 165 mo, P=0.008) and late disease recurrence (P=0.009). AR expression had a positive significant correlation with PR (P<0.001) and ER (P=0.037) expression. AR might play a role as a prognostic marker for ECs.
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Simitsidellis I, Saunders PTK, Gibson DA. Androgens and endometrium: New insights and new targets. Mol Cell Endocrinol 2018; 465:48-60. [PMID: 28919297 DOI: 10.1016/j.mce.2017.09.022] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 09/08/2017] [Accepted: 09/14/2017] [Indexed: 12/21/2022]
Abstract
Androgens are synthesised in both the ovary and adrenals in women and play an important role in the regulation of female fertility, as well as in the aetiology of disorders such as polycystic ovarian syndrome, endometriosis and endometrial cancer. The endometrium is an androgen target tissue and the impact of AR-mediated effects has been studied using human endometrial tissue samples and rodent models. In this review we highlight recent evidence that endometrial androgen biosynthesis and intracrine action is important in preparation of a tissue microenvironment that can support implantation and establishment of pregnancy. The impact of androgens on endometrial cell proliferation, in repair of the endometrial wound at the time of menstruation and in endometrial disorders is discussed. Future directions for research focused on AR function as a therapeutic target are considered.
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Affiliation(s)
- Ioannis Simitsidellis
- Medical Research Council Centre for Inflammation Research, The University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Philippa T K Saunders
- Medical Research Council Centre for Inflammation Research, The University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Douglas A Gibson
- Medical Research Council Centre for Inflammation Research, The University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK.
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Abstract
Heavy menstrual bleeding (HMB) is a common gynecological complaint with multiple etiologies and diverse pathophysiological origins. This review discusses HMB with reference to the recently proposed PALM-COEIN classification system for abnormal uterine bleeding, initially describing the endometrial events in normal menstruation followed by discussion of the perturbations of normal endometrial shedding that can result in HMB. Our present understanding of the mechanisms of menstrual bleeding as well as many of the pathological aberrations of HMB is incomplete. Further research into the pathophysiology of HMB is urgently needed, as clear knowledge of the mechanisms of this disorder will provide new therapeutic targets to formulate more effective treatments.
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Affiliation(s)
- Dharani K Hapangama
- Department of Women's & Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool Women's Hospital, Crown Street, Liverpool, L8 7SS, UK
| | - Judith N Bulmer
- Reproductive & Vascular Biology Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
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Yun BH, Jeon YE, Seo SK, Park JH, Yoon SO, Cho S, Choi YS, Lee BS. Effects of a Levonorgestrel-Releasing Intrauterine System on the Expression of Steroid Receptor Coregulators in Adenomyosis. Reprod Sci 2015; 22:1539-48. [DOI: 10.1177/1933719115589411] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Bo Hyon Yun
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Eun Jeon
- Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seok Kyo Seo
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joo Hyun Park
- Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sun Och Yoon
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - SiHyun Cho
- Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Sik Choi
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byung Seok Lee
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
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Li X, Liu X, Guo SW. Clinical profiles of 710 premenopausal women with adenomyosis who underwent hysterectomy. J Obstet Gynaecol Res 2013; 40:485-94. [PMID: 24148010 DOI: 10.1111/jog.12211] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 06/16/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Xuelian Li
- Department of Gynecology; Fudan University; Shanghai China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai OB/GYN Hospital; Fudan University; Shanghai China
| | - Xishi Liu
- Department of Gynecology; Fudan University; Shanghai China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai OB/GYN Hospital; Fudan University; Shanghai China
| | - Sun-Wei Guo
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai OB/GYN Hospital; Fudan University; Shanghai China
- Department of Biochemistry; Shanghai Medical College; Fudan University; Shanghai China
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Koike E, Yasuda Y, Shiota M, Shimaoka M, Tsuritani M, Konishi H, Yamasaki H, Okumoto K, Hoshiai H. Exposure to ethinyl estradiol prenatally and/or after sexual maturity induces endometriotic and precancerous lesions in uteri and ovaries of mice. Congenit Anom (Kyoto) 2013; 53:9-17. [PMID: 23480353 DOI: 10.1111/j.1741-4520.2012.00383.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 07/29/2012] [Indexed: 11/28/2022]
Abstract
Unrecognizable exposure to estrogenic substance may cause estrogen-dependent diseases, endometriosis and cancer. Pregnant mice (ICR/Jcl, CLEA) were exposed to 0.01 mg ethinyl estradiol (EE2 )/kg per day or vehicle (olive oil) through oral intubation from day 11 to 17 of gestation. They delivered their offspring and raised them. When the experimental female F1 mice were at 8 weeks of age, they were not exposed to EE2 or to the same dose of EE2 or to vehicle twice a week until 20 weeks of age. The control female F1 mice were exposed to the same dose of EE2 or vehicle alone, similarly. All mice were killed at 28 weeks of age. The resected uteri and ovaries were processed for microscopic examinations and for determination of the aromatase mRNA levels and aromatase protein through quantitative RT-PCR and Western blotting, respectively. Adenomyosis and adenocarcinomatous changes were significantly discernible in the EE2 -exposed uteri, and incidence of ectopic glands and serous cysts were significantly increased in the prenatally EE2 -exposed ovaries as compared with respective controls. Significant upregulation of the aromatase mRNA was seen in the prenatally EE2 -exposed uteri and in the EE2 -exposed ovaries. The aromatase protein was identified in all ovaries examined, and in EE2 -exposed uteri but not in controls and confirmed its localization in eutopic and ectopic glands, abnormally proliferated lesions and the lining of the cysts. Taken together, continuous EE2 exposure may cause endometriotic and precancerous lesions due to excessive estrogen synthesis in both target organs.
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Affiliation(s)
- Eiji Koike
- Department of Obstetrics and Gynecology, Kinki University School of Medicine, Osakasayama, Japan
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Bouquet de Jolinière J, Ayoubi JM, Lesec G, Validire P, Goguin A, Gianaroli L, Dubuisson JB, Feki A, Gogusev J. Identification of displaced endometrial glands and embryonic duct remnants in female fetal reproductive tract: possible pathogenetic role in endometriotic and pelvic neoplastic processes. Front Physiol 2012; 3:444. [PMID: 23227010 PMCID: PMC3512110 DOI: 10.3389/fphys.2012.00444] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 10/24/2012] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Recent findings strongly promoted the hypothesis that common pelvic gynecological diseases including endometriosis and ovarian neoplasia may develop de novo from ectopic endometrial-like glands and/or embryonic epithelial remnants. To verify the frequency, the anatomical localization and the phenotype of misplaced endometrial tissue along the fetal female reproductive tract, histological and immunohistochemical analyses of uteri, fallopian tubes, and uterosacral ligaments were performed. METHODS Reproductive organs were collected from seven female fetuses at autopsy, five of them from gestational ages between 18 and 26 weeks and two fetuses with gestational ages of 33 and 36 weeks deceased of placental anomalies. Serial sections from areas containing ectopic glands and embryonic duct residues were analyzed by histological and immunohistochemical procedures. RESULTS Numerous ectopic endometrial glands and stroma were detected in the myometrium in two fetuses with low levels of expression of estrogen receptor-alpha (ER-α) and progesterone receptors (PR). The embryonic ducts were localized in the uterine broad and ovarian ligaments and under the fallopian tube serosa in six fetuses. Low levels of steroid receptors expression were found in the embryonic residues, whereas the carcino-embryonic antigen (CEA) and the tumor marker Ca 125 were not detected. The embryonic residues stromal component strongly expressed the CD 10 and vimentin proteins. CONCLUSION The anatomical and the immunohistochemical features of the ectopic organoid structures identified in fetal female reproductive tract suggest that endometriotic as well as neoplastic disease in adult women may develop on the basis of misplaced endometrial glands and/or embryonic cell remnants.
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Guo SW. The endometrial epigenome and its response to steroid hormones. Mol Cell Endocrinol 2012; 358:185-96. [PMID: 22067514 DOI: 10.1016/j.mce.2011.10.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 10/21/2011] [Accepted: 10/21/2011] [Indexed: 01/21/2023]
Abstract
The human endometrium undergoes cyclic morphological and functional changes during the menstrual cycle. These changes are driven mainly by steroid hormones and orchestrated by a myriad of genes - many of which have been identified recently as being epigenetically regulated. Epigenetic modifications, including DNA methylation and histone acetylations, are shown recently to be involved in functional changes in endometrium and endometrial diseases. Since epigenetics itself is a rapidly evolving field, this review starts with an overview of epigenetics and its intrinsic connections with endometrial response to steroid hormones, highlighting its various levels of complexities. This is followed by a review of published and unpublished work on "writers", "erasers", and other players of endometrial epigenome. In the end, areas in need for future research in this area will be exposed.
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Affiliation(s)
- Sun-Wei Guo
- Shanghai Obstetric and Gynecologic Hospital, and Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Fudan University Shanghai College of Medicine, 419 Fangxie Road, Shanghai 200011, China.
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Yin X, Pavone ME, Lu Z, Wei J, Kim JJ. Increased activation of the PI3K/AKT pathway compromises decidualization of stromal cells from endometriosis. J Clin Endocrinol Metab 2012; 97:E35-43. [PMID: 22072736 PMCID: PMC3251935 DOI: 10.1210/jc.2011-1527] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
CONTEXT Endometriosis affects approximately 10% of women in the United States and causes pain and infertility. Decidualization of endometrial stromal cells from women with endometriosis is aberrant. OBJECTIVE The objective of this study was to investigate a potential mechanism for the inadequate decidual response in stromal cells from ovarian endometriomas. DESIGN Stromal cells of the endometrium from women without endometriosis (HSC) or from ovarian endometriomas (OsisSC) were grown in culture and treated with 10 μm LY294002 or 250 nm MK2206, 100 nm medroxyprogesterone acetate (M), and 0.5 mm dibutyryl cAMP (A) or infection with 100 multiplicity of infection adenoviral constructs containing wild-type Forkhead box O1 or triple-mutant FOXO1. Real-time PCR was used to measure the expression of FOXO1, IGF binding protein-1 (IGFBP1), and prolactin (PRL) mRNA, and Western blot and immunohistochemical staining were used to detect the levels of progesterone receptor (PR), FOXO1, AKT, and p(Ser473)-AKT protein in vitro or in vivo. RESULTS Expression of the decidua-specific genes, IGFBP1 and PRL, were significantly lower in OsisSC compared with normal HSC in response to M+A treatment. Basal expression levels of PRA, PRB, and FOXO1 proteins were dramatically lower in OsisSC. Overexpression of triple-mutant FOXO1 increased mRNA levels of IGFBP1 and PRL in OsisSC in the presence of M+A, whereas the overexpression of wild-type FOXO1 had no effect. AKT was highly phosphorylated in OsisSC compared with HSC and inhibition of phosphatidylinositol 3-kinase, with LY294002, increased levels of FOXO1 protein as well as IGFBP1 mRNA in the presence of M+A. Moreover, inhibition of AKT with MK2206, an allosteric AKT inhibitor, dramatically increased the accumulation of nuclear FOXO1 as well as expression of IGFBP1. Finally, immunohistochemical staining demonstrated higher p(Ser473)-AKT and lower FOXO1 levels in endometriosis tissues, compared with normal endometrial tissues. CONCLUSIONS In endometriotic stromal cells, overactivation of the phosphatidylinositol 3-kinase/AKT signaling pathway contributes to the reduced expression of the decidua-specific gene, IGFBP1, potentially through reduced levels of nuclear FOXO1.
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Affiliation(s)
- Xunqin Yin
- Division of Reproductive Biology Research, Northwestern University, Chicago, Illinois 60611, USA
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Zhao H, Wang Q, Bai C, He K, Pan Y. A cross-study gene set enrichment analysis identifies critical pathways in endometriosis. Reprod Biol Endocrinol 2009; 7:94. [PMID: 19735579 PMCID: PMC2752458 DOI: 10.1186/1477-7827-7-94] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2009] [Accepted: 09/08/2009] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Endometriosis is an enigmatic disease. Gene expression profiling of endometriosis has been used in several studies, but few studies went further to classify subtypes of endometriosis based on expression patterns and to identify possible pathways involved in endometriosis. Some of the observed pathways are more inconsistent between the studies, and these candidate pathways presumably only represent a fraction of the pathways involved in endometriosis. METHODS We applied a standardised microarray preprocessing and gene set enrichment analysis to six independent studies, and demonstrated increased concordance between these gene datasets. RESULTS We find 16 up-regulated and 19 down-regulated pathways common in ovarian endometriosis data sets, 22 up-regulated and one down-regulated pathway common in peritoneal endometriosis data sets. Among them, 12 up-regulated and 1 down-regulated were found consistent between ovarian and peritoneal endometriosis. The main canonical pathways identified are related to immunological and inflammatory disease. Early secretory phase has the most over-represented pathways in the three uterine cycle phases. There are no overlapping significant pathways between the dataset from human endometrial endothelial cells and the datasets from ovarian endometriosis which used whole tissues. CONCLUSION The study of complex diseases through pathway analysis is able to highlight genes weakly connected to the phenotype which may be difficult to detect by using classical univariate statistics. By standardised microarray preprocessing and GSEA, we have increased the concordance in identifying many biological mechanisms involved in endometriosis. The identified gene pathways will shed light on the understanding of endometriosis and promote the development of novel therapies.
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Affiliation(s)
- Hongbo Zhao
- School of Agriculture and Biology, Shanghai Jiao Tong University, Shanghai, PR China
- Shanghai Key Lab for Veterinary Biotechnology, Shanghai, 200240, PR China
| | - Qishan Wang
- School of Agriculture and Biology, Shanghai Jiao Tong University, Shanghai, PR China
- Shanghai Key Lab for Veterinary Biotechnology, Shanghai, 200240, PR China
| | - Chunyan Bai
- School of Agriculture and Biology, Shanghai Jiao Tong University, Shanghai, PR China
- Shanghai Key Lab for Veterinary Biotechnology, Shanghai, 200240, PR China
| | - Kan He
- School of Agriculture and Biology, Shanghai Jiao Tong University, Shanghai, PR China
- Shanghai Key Lab for Veterinary Biotechnology, Shanghai, 200240, PR China
| | - Yuchun Pan
- School of Agriculture and Biology, Shanghai Jiao Tong University, Shanghai, PR China
- Shanghai Key Lab for Veterinary Biotechnology, Shanghai, 200240, PR China
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Toppila M, Willcocks D, Tyler JPP, Dillenbeck CF, Baird PJ, Crandon AJ, Eastman CJ, Hudson CN. Sex steroid receptors in gynaecological malignancy. J OBSTET GYNAECOL 2009. [DOI: 10.3109/01443618309071235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Khan KN, Kitajima M, Hiraki K, Fujishita A, Sekine I, Ishimaru T, Masuzaki H. Immunopathogenesis of pelvic endometriosis: role of hepatocyte growth factor, macrophages and ovarian steroids. Am J Reprod Immunol 2009; 60:383-404. [PMID: 19238747 DOI: 10.1111/j.1600-0897.2008.00643.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Endometriosis, a chronic disease characterized by endometrial tissue located outside the uterine cavity is associated with chronic pelvic pain and infertility. However, an in-depth understanding of the pathophysiology of endometriosis is still elusive. It is generally believed that besides ovarian steroid hormones, the growth of endometriosis can be regulated by innate immune system in pelvic microenvironment by their interaction with endometrial cells and immune cells. We conducted a series of studies in perspectives of pelvic inflammation that is triggered primarily by bacterial endotoxin (lipopolysaccharide) and is mediated by toll-like receptor 4 and showed their involvement in the development of pelvic endometriosis. As a cellular component of innate immune system, macrophages were found to play a central role in inducing pelvic inflammatory reaction. We further report here that peritoneal macrophages retain receptors encoding for estrogen and progesterone and ovarian steroids also participate in producing an inflammatory response in pelvic cavity and are involved in the growth of endometriosis either alone or in combination with hepatocyte growth factor (HGF). As a pleiotropic growth factor, HGF retains multifunctional role ometriosis. We describe here the individual and step-wise role of HGF, macrophages and ovarian steroid hormones and their orchestrated involvement in the immunopathogenesis of pelvic endometriosis.
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Affiliation(s)
- Khaleque Newaz Khan
- Department of Obstetrics and Gynecology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
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Effect of levonorgestrel and mifepristone on endometrial receptivity markers in a three-dimensional human endometrial cell culture model. Fertil Steril 2009; 91:256-64. [DOI: 10.1016/j.fertnstert.2007.11.007] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2007] [Revised: 11/06/2007] [Accepted: 11/06/2007] [Indexed: 11/18/2022]
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Abstract
Like endometriosis and uterine myomas, adenomyosis presents the typical characteristics of oestrogen-dependent diseases. The medical treatment of adenomyosis is based on the hormonal dependency of the disease and its strongly debated similarities with endometriosis. Infact, despite the evident differences between the two conditions, the therapies that treat endometriosis effectively have also been successful for the treatment of adenomyosis. Although the two diseases have distinct epidemiological features, they have the same 'target tissue' for hormonal therapy, namely ectopic endometrium. Recognized approaches are systemic hormonal treatments, which are generally used for endometriosis and are capable of suppressing the oestrogenic induction of the disease, and local hormonal treatment that targets the ectopic endometrium directly. Gonadotropin-releasing hormone agonists, danazol and intrauterine levonorgestrel- or danazol-releasing devices have been used in the treatment of adenomyosis. Despite the solid rational basis for its hormonal treatment, few studies have been performed on medical therapy for adenomyosis.
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Affiliation(s)
- Luigi Fedele
- Fondazione Policlinico, Mangiagalli e Regina Elena, Clinica Ostetrica e Ginecologica II, Università di Milano, Istituto Luigi Mangiagalli, Via della Commenda 12, 20122 Milano, Italy.
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Surrey ES. The role of progestins in treating the pain of endometriosis. J Minim Invasive Gynecol 2007; 13:528-34. [PMID: 17097575 DOI: 10.1016/j.jmig.2006.06.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2006] [Accepted: 06/10/2006] [Indexed: 11/20/2022]
Abstract
Progestins, synthetic progestational agents, have been used in the management of symptomatic endometriosis both as primary therapy and as an adjunct to surgical resection. A variety of oral agents have been employed in this regard with investigators demonstrating differing degrees of benefit. Unfortunately, due to the lack of large-scale, appropriately controlled, randomized trials, or dose-ranging studies, no single agent can be demonstrated to be truly efficacious. The lack of a standardized instrument to evaluate painful symptoms makes comparative analysis more difficult. Injectable administration of long-acting depot medroxyprogesterone acetate preparations intramuscularly or subcutaneously has been investigated in three randomized trials. The lower dose subcutaneous injection holds promise with an apparent reduction in side effects. Issues of reversible bone mineral density loss, breakthrough bleeding, and return of menses have not been completely resolved. Selective progesterone receptor modulators represent an intriguing alternative. These orally administered agents have been shown in preliminary investigations to be not only efficacious in reducing symptoms but also associated with minimal side effects. Further investigation of these agents is clearly required.
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Affiliation(s)
- Eric S Surrey
- Colorado Center for Reproductive Medicine, Englewood, Colorado, USA.
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Guo SW, Olive DL. Two Unsuccessful Clinical Trials on Endometriosis and a Few Lessons Learned. Gynecol Obstet Invest 2007; 64:24-35. [PMID: 17202821 DOI: 10.1159/000098413] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In 1999, a phase II clinical trial on the use of fulvestrant to treat endometriosis was launched; yet after 7 years there is still no report on its outcome. In 2005, another trial on the use of raloxifene to treat endometriosis was terminated early due to unfavorable outcome. The two apparently unsuccessful clinical trials on endometriosis have taught us a few important lessons. First, we need to understand endometriosis through more basic research. We have also been reminded that human endometriosis trials differ from animal studies; anatomy and physiology are often divergent, and outcome measures are certainly different. Ectopic endometrium can differ significantly from eutopic tissue, and this issue needs to be more thoroughly explored. We believe human cell lines will prove to be an inexpensive and valuable tool for future preliminary evaluation of medical therapies as well as discerning pathophysiologic processes of the disease. Based on our current understanding of endometriosis, some concrete benchmarks can be established for testing or screening potential compounds in vitro. Finally, estrogen receptor modulators are often tissue-, cell-, and context-specific in their actions; they should not be simplistically grouped together nor should extrapolations from one compound to another be undertaken in a cavalier manner.
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Affiliation(s)
- Sun-Wei Guo
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI 53226-0509, USA.
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Levgur M. Therapeutic options for adenomyosis: a review. Arch Gynecol Obstet 2006; 276:1-15. [PMID: 17186255 DOI: 10.1007/s00404-006-0299-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2006] [Accepted: 11/22/2006] [Indexed: 12/29/2022]
Abstract
BACKGROUND To review the literature on various therapeutic modalities for uterine adenomyosis. METHODS Reviews, case-controlled studies and reports from November 1949 until August 2006 written in English or summarized in English abstracts retrieved from Medline and Pubmed using the key words: adenomyosis and adenomyosis therapy. RESULTS Symptoms of adenomyosis may be alleviated by antiprostaglandins, sex hormones, danazol and GnRH analogs. Minor surgical procedures for therapy include endomyometrial ablation, laparoscopic myometrial electrocoagulation and adenomyoma excision. Patient's age and symptoms, desired fertility, site and extent of lesion and surgeon's skills should be considered in choosing the appropriate procedure. Endomyometrial ablation is effective for lesions deeper than the endometrial-myometrial junction whereas the efficacy of hysteroscopic ablation is limited to foci 2-3 mm deep. Focal and diffuse disease may be managed by laparoscopic electrocoagulation or myometrial excision with preservation of fertility but risk of recurrence exists. Uterine artery embolization assumingly invokes infarction and necrosis. Encouraging results reported in some cases warrant expanding its use for more experience. Hysterectomy is the ultimate solution for women with deep myometrial involvement or if future fertility is not desired. CONCLUSIONS Various therapeutic options for adenomyosis, including few minimally invasive procedures became available in the last two decades but need evaluation and improvement.
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Affiliation(s)
- Michael Levgur
- Department of Obstetrics and Gynecology, Maimonides Medical Center, 967 48th street, Brooklyn, NY, USA.
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Kitawaki J. Adenomyosis: the pathophysiology of an oestrogen-dependent disease. Best Pract Res Clin Obstet Gynaecol 2006; 20:493-502. [PMID: 16564227 DOI: 10.1016/j.bpobgyn.2006.01.010] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Adenomyosis uteri is a common gynaecological disorder that is characterized by the presence of ectopic endometrial glands and stroma in the myometrium. Although adenomyosis and endometriosis are different diseases, both of them grow and regress in an oestrogen-dependent fashion. Polymorphisms in the oestrogen receptor alpha gene are associated with a risk of adenomyosis. Adenomyotic tissue contains steroid receptors as well as aromatase and sulphatase enzymes. Together with the circulating oestrogen, locally produced oestrogens stimulate the growth of tissue mediated by the oestrogen receptors. Oestrogen metabolism, including the expression pattern of aromatase and the regulation of 17beta-hydroxysteroid dehydrogenase type 2 is altered in the eutopic endometrium of women with endometriosis, adenomyosis, and/or leiomyomas compared to that in the eutopic endometrium of women without disease. In addition to the conventional hormonal treatment with gonadotropin-releasing hormone agonists and danazol, the use of steroid-releasing intrauterine devices may be applicable to clinics.
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Affiliation(s)
- Jo Kitawaki
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan.
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Wéry O, Thille A, Gaspard U, van den Brûle F. [Adenomyosis: update on a frequent but difficult diagnosis]. ACTA ACUST UNITED AC 2006; 34:633-48. [PMID: 16270001 DOI: 10.1016/s0368-2315(05)82896-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Adenomyosis is a frequent entity, with difficult diagnosis, often obtained by pathological analysis performed after hysterectomy. This condition can cause abnormal uterine bleeding and dysmenorrhea, frequent reasons for consultation and hysterectomy. The development of ultrasonographic and magnetic resonance imaging techniques allow preoperative diagnosis. They also permit the use of hysteroscopic techniques for conservative uterine surgery, and have brought diagnosis and management of this disease to the front of the scene. This article reviews the pathological description of the disease, its epidemiology, clinical presentations, useful and necessary explorations, etiopathogeny and available therapies.
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Affiliation(s)
- O Wéry
- Service de Gynécologie, CHU Sart-Tilman
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Okamura H, Katabuchi H, Nitta M, Ohtake H. Structural changes and cell properties of human ovarian surface epithelium in ovarian pathophysiology. Microsc Res Tech 2006; 69:469-81. [PMID: 16718660 DOI: 10.1002/jemt.20306] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The surface epithelial cells of the ovary, which are modified peritoneal cells, form a single, focally pseudostratified layer. The Müllerian ducts differentiate after invagination of the coelomic mesothelium over the gonadal ridges during the 6th week of embryonic life. On the basis of the embryologically putative Müllerian potential of this epithelium, endometriosis can be explained by coelomic metaplasia from the peritoneum, including ovarian surface epithelium. Some pelvic endometriosis specimens have shown that epithelial cells on the ovary or pelvis are serially changed to endometriotic gland cells. Immunohistochemistry as well as scanning electron microscopy also reinforce the light-microscopical findings. A three-dimensional culture system demonstrated that human ovarian surface epithelial cells exhibited a glandular-stromal structure when they were cocultured with endometrial stromal cells in an estrogen-rich environment. Ovarian carcinomas in the epithelial-stromal category are thought to arise from the surface epithelium and its inclusions. The ovarian surface epithelium is physiologically involved in follicular rupture, oocyte release, and the subsequent repair of follicle wall during reproductive age. Simultaneously, ovulation may cause a loss of integrity of the surface epithelium, followed by accumulation of multiple mutations. The cortical invagination, surface stromal proliferation, and Müllerian differentiation of these cells are likely not to be an early step in the cancer development. However, the inclusion cysts are closely related with carcinogenesis because they are significantly more common in ovaries contralateral to those containing epithelial cancers than in control ovaries. As an in vitro study, ovarian carcinoma cell lines were established from simian virus 40 large T antigen-transformed human surface epithelial cells of the ovary. Further investigations of these cell lines may lead to insights into the preneoplastic and early stages of carcinomas. To clarify the pathogenesis of endometriosis and epithelial ovarian cancer, specifically designed studies of ovarian surface epithelium are required.
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Affiliation(s)
- Hitoshi Okamura
- Department of Reproductive Medicine, Kumamoto University, Kumamoto 860-8556, Japan.
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Deffieux X, Fernandez H. Évolutions physiopathologiques, diagnostiques et thérapeutiques dans la prise en charge de l’adénomyose : revue de la littérature. ACTA ACUST UNITED AC 2004; 33:703-12. [PMID: 15687941 DOI: 10.1016/s0368-2315(04)96631-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Adenomyosis is a relatively frequent disease of unknown origin, which is difficult to diagnose. Appropriate treatment for women who want to preserve or improve their fertility remains to be defined. METHODS This review summarized the reports found on Medline database about pathophysiology, diagnosis and management of adenomyosis. RESULTS Many pathophysiological factors may be involved in the occurrence of adenomyosis: immunological factors, estrogen sulfatase activity, tenascin which is a fibronectin inhibitor and angiogenesis and growth factors such as EGF, VEGF and GM-CSF. Endovaginal ultrasonography seems to be as effective as MRI for the diagnosis of adenomyosis. GnRH agonist decreases symptoms and uterine volume; however, the symptoms reappear after discontinuation of agonist therapy, and side effects limit their prolonged use. Progesterone receptor modulators, anti-progestative and danazol or levonorgestrel-releasing intra-uterine system have been used as therapeutic modalities for adenomyosis, but the lack of controlled studies make their efficacy difficult to quantify. Some women with superficial adenomyosis may theoretically benefit from hysteroscopic myometrial or endometrial resection, but these procedures would be limited to women not wishing to conceive. Laparoscopic myometrial electrocoagulation or excision has proven to be effective but pregnancy following these techniques poses special problems, particularly the increased risk of uterine rupture. CONCLUSION Transvaginal ultrasonography can successfully diagnose adenomyosis. Medical and conservative surgical treatments are already available.
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Affiliation(s)
- X Deffieux
- Service de Gynécologie-Obstétrique, Hôpital Antoine Béclère, 157, rue de la Porte-de-Trivaux, 92141 Clamart Cedex
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Donnez J, Squifflet J, Casanas-Roux F, Pirard C, Jadoul P, Van Langendonckt A. Typical and subtle atypical presentations of endometriosis. Obstet Gynecol Clin North Am 2003; 30:83-93, viii. [PMID: 12699259 DOI: 10.1016/s0889-8545(02)00054-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The diagnosis of peritoneal endometriosis at the time of laparoscopy is often made by the observation of typically puckered black or bluish lesions. There are also numerous subtle appearances of peritoneal endometriosis. The lesions are frequently non-pigmented. Red flame-like lesions, glandular excrescences, and subovarian adhesions must be considered as the most active lesions. Sometimes, however, subtle endometriotic lesions can be the only lesions seen at laparoscopy.
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Affiliation(s)
- Jacques Donnez
- Department of Gynecology, St. Luc's Hospital, Université Catholique de Louvain, Avenue Hippocrate, 1200 Brussels, Belgium.
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Abstract
Adenomyosis is characterized as ectopic endometrial tissues within the myometrium in the uterus. The etiology and pathogenetic mechanism(s) responsible for adenomyosis are poorly understood. Definite diagnosis is made on hysterectomy specimens, although attempts are made at securing preoperative diagnosis by magnetic resonance imaging and myometrial biopsies. Definite treatment of symptomatic women is hysterectomy.
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Affiliation(s)
- I M Matalliotakis
- Department of Obstetrics and Gynecology, University of Crete, Heraklion, Greece
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Kitawaki J, Kado N, Ishihara H, Koshiba H, Kitaoka Y, Honjo H. Endometriosis: the pathophysiology as an estrogen-dependent disease. J Steroid Biochem Mol Biol 2002; 83:149-55. [PMID: 12650711 DOI: 10.1016/s0960-0760(02)00260-1] [Citation(s) in RCA: 265] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Endometriosis, defined as the presence of endometrial glands and stroma outside of the uterine cavity, develops mostly in women of reproductive age and regresses after menopause or ovariectomy, suggesting that the growth is estrogen-dependent. Indeed, the lesions contain estrogen receptors (ER) as well as aromatase, an enzyme that catalyses the conversion of androgens to estrogens, suggesting that local estrogen production may stimulate the growth of lesions. The expression patterns of ER and progesterone receptors in endometriotic lesions are different from those in the eutopic endometrium. Moreover, estrogen metabolism, including the expression pattern of aromatase and the regulation of 17 beta-hydroxysteroid dehydrogenase type 2 (an enzyme responsible for the inactivation of estradiol to estrone), is altered in the eutopic endometrium of women with endometriosis, adenomyosis, and/or leiomyomas compared to that in the eutopic endometrium of women without disease. Immunostaining for P450arom in endometrial biopsy specimens diagnosed these diseases with sensitivity and specificity of 91 and 100%, respectively. This is applicable to the clinical diagnosis of endometriosis. The polymorphisms in the ER-alpha gene, the CYP19 gene encoding aromatase, and several other genes are associated with the risk of endometriosis. Studies of these will lead to better understandings of the etiology and pathophysiology of endometriosis.
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Affiliation(s)
- J Kitawaki
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, 465 Kajii-Cho Kamigyo-Ku, Kyoto 602-8566, Japan.
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Bazot M, Daraï E, Rouger J, Detchev R, Cortez A, Uzan S. Limitations of transvaginal sonography for the diagnosis of adenomyosis, with histopathological correlation. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2002; 20:605-611. [PMID: 12493051 DOI: 10.1046/j.1469-0705.2002.00852.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVES To evaluate the accuracy of transabdominal sonography (TAS) and transvaginal sonography (TVS) for the diagnosis of adenomyosis, and to determine the diagnostic relevance of various sonographic criteria. SUBJECTS AND METHODS A total of 129 women scheduled for hysterectomy were enrolled into this prospective study. Group 1 (n = 23) consisted of patients with menometrorrhagia who were free of myoma and endometrial disorders on TAS. Group 2 consisted of all the other patients (n = 106). TAS and TVS findings were compared to histopathological results. RESULTS The prevalence of adenomyosis in Groups 1 and 2 was 91.3% and 24.5%, respectively. TAS had limited value for the diagnosis of adenomyosis in both groups. The sensitivity, specificity, and positive and negative predictive values of TVS in Groups 1 and 2 were 80.9% and 38.4%, 100% and 97.5%, 100% and 83.3%, and 40% and 82.9%, respectively. The accuracy of combined TAS and TVS in Groups 1 and 2 was 91.3% and 83%, respectively. The presence of myometrial cysts was the most specific ultrasound diagnostic criterion for adenomyosis. Hypoechoic linear myometrial striations related to the presence of myometrial hypertrophy correlated to hormonal status with a sensitivity of 66.6% and a specificity of 100% in Group 1. CONCLUSIONS Our results show that TAS has a limited diagnostic capacity for adenomyosis but also that TVS alone was poor in patients with an enlarged uterus. In these cases a combination of TVS and TAS should be used.
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Affiliation(s)
- M Bazot
- Department of Radiology, Hôpital Tenon, Paris, France.
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Abstract
OBJECTIVE Sampson's theory of reflux menstruation suggests that endometriosis is one form of a condition known as an autotransplant. This study seeks to characterize autotransplants as they are described in the literature and to determine whether endometriosis resembles an autotransplant. DESIGN Literature review of published studies containing the following types of information: [1] characterization of the histologic features, immunohistochemistry, or structural function of autotransplants; and [2] comparisons of endometriosis with endometrium. MAIN OUTCOME MEASURE(S) Characteristics of multiple types of autotransplants were noted. Similarity or dissimilarity of endometriosis and endometrium was tabulated to judge qualitatively whether the bulk of the evidence supports the notion that endometriosis is an autotransplant. RESULT(S) Autotransplants remain very similar or identical to eutopic tissues of origin, regardless of the length of time following autotransplantation. Endometriosis differs in many profound and fundamental ways from eutopic endometrium, including clonality of origin, enzymatic activity, protein expression, and histologic and morphologic characteristics. A minority of studies has found similarities between endometriosis and eutopic endometrium. CONCLUSION(S) Endometriosis is dissimilar to eutopic endometrium and therefore lacks characteristics of an autotransplant. Sampson's theory of origin of endometriosis is not supported by the results of this study. Studies of experimental endometriosis that have not used menstrual endometrium may be misleading.
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Apparao KBC, Lovely LP, Gui Y, Lininger RA, Lessey BA. Elevated endometrial androgen receptor expression in women with polycystic ovarian syndrome. Biol Reprod 2002; 66:297-304. [PMID: 11804942 DOI: 10.1095/biolreprod66.2.297] [Citation(s) in RCA: 161] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Androgen receptors (AR) have been identified in human endometrium; however, their role in endometrial cyclic development and function remains poorly understood. The objective of the present study was to investigate the profile of endometrial AR in normal menstrual cycles and in the endometrium of women with polycystic ovarian syndrome (PCOS). This syndrome is characterized by chronic hyperandrogenism and oligo-ovulation, and it is often associated with poor reproductive performance. Using immunohistochemistry and reverse transcription-polymerase chain reaction, we found that women with PCOS exhibited elevated endometrial AR expression compared to normal, fertile controls. This increase was most apparent in glandular and luminal epithelium. Furthermore, when compared to endometrium from fertile women, PCOS endometrium showed other abnormalities in endometrial development, including delay or absence of the alpha(v)beta3 integrin, a well-characterized biomarker of uterine receptivity described previously (Lessey et al., JCI 1992; 90:188-195). To better understand and to gain insights regarding these findings, we used in vitro cell-culture models to study the regulation of AR in primary endometrial stromal and the well-differentiated epithelial cell line (Ishikawa). Based on Western blot analysis, epithelial AR is up-regulated by estrogens and androgens and is inhibited by progestins and epidermal growth factor (EGF). On the other hand, EGF significantly induced the expression of alpha(v)beta3, whereas estrogen and androgen treatment inhibited its expression. Collectively, these results suggest that the poor reproductive performance observed in women with PCOS may be due, in part, to the concomitant increase in both serum androgens and elevations in endometrial AR. This combination may reduce endometrial receptivity as judged by the down-regulation of alpha(v)beta3 integrin.
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Affiliation(s)
- K B C Apparao
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of North Carolina at Chapel Hill, North Carolina 27599-7570, USA
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Kamada Y, Nakatsuka M, Asagiri K, Noguchi S, Habara T, Takata M, Kudo T. GnRH agonist-suppressed expression of nitric oxide synthases and generation of peroxynitrite in adenomyosis. Hum Reprod 2000; 15:2512-9. [PMID: 11098019 DOI: 10.1093/humrep/15.12.2512] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Because overproduction of nitric oxide (NO) and peroxynitrite is known to cause tissue injury, the expression of NO synthases (NOS) and generation of peroxynitrite were investigated in adenomyosis. Immunoreactivities to endothelial and inducible NOS demonstrated phase-dependent changes in normal endometrium, and in eutopic endometrium of adenomyosis. However, NOS were expressed throughout the menstrual cycle in ectopic endometrium from the majority of patients with adenomyosis. Nitrotyrosine, a footprint of peroxynitrite, was detected concomitantly with NOS protein. This suggested that high doses of NO and superoxide are produced in the ectopic endometrium, presumably by stimulation with bioactive molecules such as cytokines and growth factors. The expression of NOS and generation of peroxynitrite were markedly reduced by administration of gonadotrophin-releasing hormone agonists (GnRHa). The suppression of serum concentrations of nitrite/nitrate, stable metabolites of NO, by long-term administration of GnRHa was also demonstrated. The suppression of synthesis of NO and/or peroxynitrite may be part of both the therapeutic and adverse effects of GnRHa therapy.
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Affiliation(s)
- Y Kamada
- Department of Obstetrics and Gynecology, Okayama University Medical School, Okayama-city, Okayama, Japan
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Lovely LP, Appa Rao KB, Gui Y, Lessey BA. Characterization of androgen receptors in a well-differentiated endometrial adenocarcinoma cell line (Ishikawa). J Steroid Biochem Mol Biol 2000; 74:235-41. [PMID: 11162929 DOI: 10.1016/s0960-0760(00)00127-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Androgen receptors (AR) have been identified in the human endometrium, but their role in endometrial function and development towards endometrial receptivity remains poorly understood. In an effort to study the regulation and possible function in endometrial epithelium, we utilized the well-differentiated endometrial adenocarcinoma cell line, Ishikawa, as a model system. This cell line has proven to be stable, hormonally responsive, contains both estrogen and progesterone receptors, and has been shown to express endometrial proteins in a hormone responsive manner. In the present study, we demonstrate that Ishikawa cells also express AR, based on immunohistochemical staining, radioactive binding studies, RT-PCR and Northern blot analysis. The expression of AR is induced in Ishikawa cells by estrogens, similar to that reported for normal endometrium. Further, using an estrogen-responsive gene that has been characterized in this cell line, alkaline phosphatase, we show that androgens act as antiestrogens in diethylstilbestrol (DES) treated cells, inhibiting enzymatic activity in a dose-dependent manner. These data support a physiologic role for AR in the endometrium. Elevations in endometrial AR in certain clinical situations such as polycystic ovarian syndrome (PCOS) may amplify the effects of androgens on the endometrium leading to suspected defects in uterine receptivity, higher than expected infertility and high miscarriage rates observed in patients with this disorder.
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Affiliation(s)
- L P Lovely
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, CB # 7570 Old Clinic Building, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7570, USA
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Frackiewicz EJ. Endometriosis: an overview of the disease and its treatment. JOURNAL OF THE AMERICAN PHARMACEUTICAL ASSOCIATION (WASHINGTON, D.C. : 1996) 2000; 40:645-57; quiz 699-702. [PMID: 11029846 DOI: 10.1016/s1086-5802(16)31105-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To review endometriosis, its etiology, clinical presentation, and current management options. DATA SOURCES Published articles identified through MEDLINE (1966-2000) using the search term "endometriosis" and the additional terms "etiology" and "treatment." Additional articles were identified from the bibliographies of the retrieved articles. DATA SYNTHESIS Endometriosis, a disease that affects the physical health and emotional well-being of many women of reproductive age, is defined as the presence of endometrial tissue outside its normal location in the uterus. The disease ranges in severity from mild to severe, and patients may be asymptomatic or experience severe and potentially incapacitating symptoms, such as dysmenorrhea, dyspareunia, and infertility. The diagnosis can be confirmed only by direct visualization using laparoscopy and biopsy. The risk of endometriosis is increased in women who have an affected first-degree relative or who have shorter menstrual cycle lengths, longer duration of menstrual flow, and low parity. The etiology of endometriosis is not yet fully understand, but may involve retrograde menstruation, hereditary factors, and impaired immune function. Treatment should be individualized for each patient, taking into account the therapeutic goals, the extent of disease, symptomatology, and the woman's age and overall health. Treatment options include expectant management, hormonal therapies to suppress ovarian steroidogenesis and induce endometrial atrophy, and surgery to remove visible lesions or, as a last resort, the uterus and ovaries. CONCLUSION Although the precise etiology of endometriosis remains a mystery, treatment options have improved considerably in recent years. Pharmacists are well positioned to identify women with unexplained pelvic pain or infertility that may be indicative of endometriosis and refer them to their physicians for further evaluation. Pharmacists also can play an important role in counseling patients about the safe and effective use of the various treatments for this disease and strategies to recognize and reduce adverse effects.
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Kitawaki J, Kusuki I, Koshiba H, Tsukamoto K, Fushiki S, Honjo H. Detection of aromatase cytochrome P-450 in endometrial biopsy specimens as a diagnostic test for endometriosis. Fertil Steril 1999; 72:1100-6. [PMID: 10593388 DOI: 10.1016/s0015-0282(99)00424-0] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate the clinical usefulness of examining endometrial biopsy specimens for aromatase cytochrome P-450 as a diagnostic test for endometriosis. DESIGN Retrospective, case-controlled study. SETTING Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Kyoto, Japan. PATIENT(S) One hundred five women of reproductive age with normal menstrual cycles underwent endometrial biopsy laparotomy or laparoscopy, and examination of their tissue revealed endometriosis, adenomyosis, and/or leiomyomas. Patients who had cervical carcinoma in situ but no other gynecologic disease were considered to be disease-free. INTERVENTION(S) Endometrial biopsy specimens were collected. MAIN OUTCOME MEASURE(S) The expression of aromatase cytochrome P-450 was examined by reverse transcription-polymerase chain reaction and immunohistochemical analysis. The distribution and intensity of the immunostaining was assessed using a semiquantitative index designed H-score. RESULT(S) Immunostaining for aromatase cytochrome P-450 was detected in biopsy specimens obtained from patients with endometriosis, adenomyosis, and/or leiomyomas but not in specimens obtained from disease-free patients (H-score <20), with a sensitivity and specificity of 91% and 100%, respectively. CONCLUSION(S) The expression of aromatase cytochrome P-450 in biopsy specimens of eutopic endometrium distinguishes between disease-free women and women with endometriosis, adenomyosis, and/or leiomyomas. This technique can be used at outpatient infertility clinics as an initial screening procedure to rule out the presence of estrogen-dependent disease.
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Affiliation(s)
- J Kitawaki
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Japan.
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Misao R, Sun WS, Iwagaki S, Fujimoto J, Tamaya T. Identification of various exon-deleted progesterone receptor mRNAs in human endometrium and ovarian endometriosis. Biochem Biophys Res Commun 1998; 252:302-6. [PMID: 9826524 DOI: 10.1006/bbrc.1998.9642] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We demonstrated the expression of various exon-deleted progesterone receptor (PR) variant mRNAs in human uterine endometrium and ovarian endometriosis using the reverse transcription-polymerase chain reaction-DNA sequencing analyses. In addition to PR wild-type mRNA, various exon-deleted PR variant mRNAs were identified in all samples analyzed. The sequence of these variants showed a perfect junction between exons surrouding the deletion area. PR wild-type, exon 6-deleted, exon 4-deleted, exon 5, 6-deleted and exon 4, 5, 6-deleted PR variant mRNAs were observed in all samples analyzed. Exon 4, 6-deleted PR mRNA was observed only in ovarian endometriosis. This is the first study to demonstrate the coexpression of various PR exon-deleted variant mRNAs with the wild-type in uterine endometrium and ovarian endometriosis. All resulting variant proteins might indicate functional diversity and modify the progestational action of wild-type PR, and thus be involved in the pathophysiology of ovarian endometriosis.
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Affiliation(s)
- R Misao
- Department of Obstetrics and Gynecology, Gifu University School of Medicine, Gifu City, Japan
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Song IO, Hong SR, Huh Y, Yoo KJ, Koong MK, Jun JY, Kang IS. Expression of vimentin and cytokeratin in eutopic and ectopic endometrium of women with adenomyosis and ovarian endometrioma. Am J Reprod Immunol 1998; 40:26-31. [PMID: 9689357 DOI: 10.1111/j.1600-0897.1998.tb00384.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PROBLEM To determine the expression of vimentin and cytokeratin in eutopic and ectopic endometrium of women with both adenomyosis and ovarian endometrioma and to evaluate their cyclic changes during the menstrual cycle. METHOD OF STUDY Twenty patients requiring hysterectomy with salpingo-oophorectomy were studied by immunohistochemistry according to their menstrual cycles. RESULTS Cyclic expression of vimentin was noted in eutopic endometrium and adenomyosis, but not in endometrioma. Cytokeratin expression did not change during the menstrual cycles. The mean intensities of epithelial vimentin were significantly different from each other, being the lowest in endometrioma, intermediate in adenomyosis, and the highest in eutopic endometrium. There was no significant difference in intensities of cytokeratin between adenomyosis and endometrioma, but these intensities were significantly lower than that of eutopic endometrium. CONCLUSIONS Lower intensities of cytokeratin in adenomyosis and endometrioma than in eutopic endometrium suggest that the ectopic endometria may have a lower degree of differentiation regardless of the site. The lower intensity of epithelial vimentin in endometrioma than in adenomyosis during the proliferative phase may reflect decreased functional activity, probably because of a pressure effect on the lining epithelium within the endometrioma.
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Affiliation(s)
- I O Song
- Department of Gynecology and Obstetrics, Samsung Cheil Hospital, College of Medicine, Sung Kyun Kwan University, Seoul, Korea
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Misao R, Nakanishi Y, Fujimoto J, Tamaya T. Expression of sex hormone-binding globulin exon VII splicing variant messenger ribonucleic acid in human ovarian endometriosis. Fertil Steril 1998; 69:324-8. [PMID: 9496349 DOI: 10.1016/s0015-0282(97)00495-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate the expression of sex hormone-binding globulin (SHBG) exon VII splicing variant messenger RNA (mRNA) in human ovarian endometriosis. DESIGN The expression of SHBG variant mRNA in normal uterine endometrium and endometriotic tissue was determined. SETTING Department of Obstetrics and Gynecology, Gifu University Hospital. PATIENT(S) Fourteen women with endometriosis and 18 women without endometriosis. INTERVENTION(S) Normal uterine endometrial and ovarian endometriotic tissues from patients who had undergone gynecological surgery were studied. MAIN OUTCOME MEASURE(S) Levels of SHBG wild-type and variant mRNAs were determined using the quantitative reverse transcription-polymerase chain reaction. RESULTS(S) Analysis of the missing base pairs proved that they corresponded to the entire exon VII. There was no significant difference between the levels of SHBG wild-type mRNA in normal endometria and in endometriotic endometria, although the levels of SHBG variant mRNA in endometriotic endometria were significantly higher than that in normal endometria. The ratio of SHBG variant to wild-type mRNA levels was significantly higher in endometriotic endometria than in normal endometria. CONCLUSION(S) This study demonstrates the coexpression of SHBG exon VII splicing variant mRNA with its wild-type and the dominant expression of the variant in ovarian endometriosis. These results might be involved in the cellular estrogenic interaction, plausibly assisting in the development and growth of ovarian endometriosis.
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Affiliation(s)
- R Misao
- Department of Obstetrics and Gynecology, Gifu University School of Medicine, Japan
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Ota H, Igarashi S, Hatazawa J, Tanaka T. Distribution of heat shock proteins in eutopic and ectopic endometrium in endometriosis and adenomyosis. Fertil Steril 1997; 68:23-8. [PMID: 9207579 DOI: 10.1016/s0015-0282(97)81470-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate the pathophysiologic role of heat shock proteins and to examine the effect of danazol on these proteins in patients with endometriosis and adenomyosis. DESIGN Immunohistochemical identification of human heat shock proteins 27, 60, and 70 in endometrial glandular cells identified using monoclonal antibodies. SETTING Department of obstetrics and gynecology in a university hospital. PATIENT(S) Subjects were 119 women with documented endometriosis or adenomyosis. The subjects were divided into three groups: fertile control (n = 38), with 14 in the proliferative phase and 24 in the secretory phase; endometriosis (n = 38); and adenomyosis (n = 43), including 33 who underwent hysterectomy and 10 treated with danazol. MAIN OUTCOME MEASURE(S) Staining of glandular cells by semiquantitative immunostaining (evaluation nomogram) score. RESULT(S) Significantly increased expression of heat shock protein 27 was noted in eutopic endometrium from patients with endometriosis and adenomyosis as compared with controls, regardless of the menstrual phase. The scores for heat shock protein 27 and heat shock protein 70 in the ectopic endometrium of patients with endometriosis were low compared with those in eutopic endometrium, whereas in adenomyosis, the scores were similar to those of eutopic endometrium. After treatment with danazol, the expression of heat shock proteins returned to control levels. CONCLUSION(S) We suggest that abnormally increased expression of heat shock proteins plays a role in the pathophysiology of endometriosis and adenomyosis.
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Affiliation(s)
- H Ota
- Department of Obstetrics and Gynecology, Akita University, School of Medicine, Japan
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Fujishita A, Nakane PK, Koji T, Masuzaki H, Chavez RO, Yamabe T, Ishimaru T. Expression of estrogen and progesterone receptors in endometrium and peritoneal endometriosis: an immunohistochemical and in situ hybridization study. Fertil Steril 1997; 67:856-64. [PMID: 9130890 DOI: 10.1016/s0015-0282(97)81397-0] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To clarify the role of ovarian steroids in the development and progression of endometriosis, estrogen receptors (ERs) and progesterone receptors (PRs) were localized by immunohistochemistry, and ER messenger RNA (mRNA) was detected by in situ hybridization in the uterine endometrium and in normal and altered pelvic peritoneum. DESIGN Retrospective and prospective study. SETTING Nagasaki University School of Medicine, Nagasaki, Japan. PATIENT(S) A retrospective study of 61 formalin-fixed uterine endometria and normal and altered pelvic peritonea from patients suffering from various gynecologic diseases was conducted. In addition, in 22 fresh frozen tissue specimens, ER mRNA expression was evaluated prospectively. MAIN OUTCOME MEASURE(S) In formalin-fixed tissues, ER and PR were localized immunohistochemically. The results of immunohistochemical staining were scored from 0 to 4, depending on the signal intensity and frequency of positive cells. In fresh frozen specimens, ER mRNA expression was assessed by nonradioactive in situ hybridization using thymine-thymine dimerized oligonucleotide probes. RESULTS The highest score of ERs and PRs was observed in the epithelial and stromal cells of the normal uterine endometrium at the early proliferative phase of the menstrual cycle. The ER and PR scores declined throughout the secretory phase. In typical endometriotic lesions, the ER and PR scores were constantly high independent of the menstrual cycle. The expression pattern of ER mRNA was mostly in parallel with that of ERs. In typical endometriosis, ERs and PRs were found in both glandular epithelial cells and their surrounding stromal cells. Expression of ER mRNA was found in typical endometriotic peritonea and in pelvic peritoneum with columnar epithelial cells, but not in normal pelvic peritoneum (mesothelium). Estrogen receptors and PRs were negative in mesothelium, but were positive in the nuclei of fibroblasts in the connective tissue. CONCLUSION(S) We demonstrated the expression of ERs, ER mRNA, and PRs in the columnar cells in pelvic peritonea and typical endometriosis, but not in normal mesothelium. These results suggest that endometriosis may originate from the columnar cells with ERs and PRs in the pelvic peritoneal lining.
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Affiliation(s)
- A Fujishita
- Department of Obstetrics and Gynecology, Nagasaki University School of Medicine, Japan
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39
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An effective minimally invasive method of treating adenomyosis by interstitial laser photocoagulation with the KTP laser. Lasers Med Sci 1997. [DOI: 10.1007/bf02763924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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40
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Misao R, Fujimoto J, Nakanishi Y, Tamaya T. Expression of estrogen and progesterone receptors and their mRNAs in ovarian endometriosis. Gynecol Endocrinol 1996; 10:303-10. [PMID: 8915659 DOI: 10.3109/09513599609012816] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
To discover the molecular mechanisms of estrogen-induced growth in ovarian endometriosis, the expression of estrogen and progesterone receptors and their mRNAs was investigated. The expression of estrogen and progesterone receptors and their mRNAs was significantly (p < 0.01) lower in endometriotic endometria than in normal endometria. The ratio of estrogen receptors: progesterone receptors was significantly (p < 0.01) higher in the endometriotic tissues than in normal proliferative- and secretory-phase endometria, as was the ratio of their respective mRNAs. These findings suggest that the absolute and relatively reduced number of estrogen receptors in ovarian endometriosis might cause the loss of control of estrogenic action, and that, furthermore, the relatively increased number of progesterone receptors might lead to an estrogen-dominant milieu, assisting in the development and growth of the ovarian endometriosis.
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Affiliation(s)
- R Misao
- Department of Obstetrics and Gynecology, Gifu University School of Medicine, Japan
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41
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Kettel LM, Murphy AA, Morales AJ, Ulmann A, Baulieu EE, Yen SS. Treatment of endometriosis with the antiprogesterone mifepristone (RU486). Fertil Steril 1996; 65:23-8. [PMID: 8557150 DOI: 10.1016/s0015-0282(16)58022-4] [Citation(s) in RCA: 175] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To evaluate the safety and efficacy of an antiprogesterone (mifepristone, RU486; Roussel-Uclaf, Romaineville, France) on endometriosis. DESIGN An open, prospective clinical trial. SETTING The clinical practice of an academic faculty. PATIENTS Nine women with endometriosis were studied. INTERVENTIONS RU486 (50 mg/d) was administered for 6 months. MAIN OUTCOME MEASURES Daily symptom inventories and urinary steroid metabolites were assessed before, during, and after treatment. Blood for hormone analysis was obtained weekly for 4 weeks and monthly thereafter. The extent of endometriosis, bone mineral density, circadian rhythm of cortisol, and LH pulsatility were determined before and after treatment. Safety laboratory measurements were made before and at 1, 2, and 6 months of treatment. RESULTS Pelvic pain and uterine cramping improved in all patients. Endometriosis regressed by 55%. All patients exhibited endocrine features of anovulatory amenorrhea without hypoestrogenism. A rise in serum LH and T levels was observed during the first month of treatment and one patient developed an elevation of liver transaminases during the last month of treatment. All other measurements were unchanged. CONCLUSION RU486 appears to be effective in improving the symptoms and causing regression of endometriosis in the absence of significant side effects.
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Affiliation(s)
- L M Kettel
- University of California-San Diego, La Jolla, USA
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42
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Regidor PA, Regidor M, Metz KA, Schindler AE. Immunohistochemical detection of estrogen and progesterone receptors in endometriotic tissue. A comparative study of paraffin embedded and fresh frozen tissues. Arch Gynecol Obstet 1994; 255:181-7. [PMID: 7695364 DOI: 10.1007/bf02335083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
30 formalin-fixed and paraffin embedded and 20 fresh frozen samples of endometriotic tissue were analysed immunohistochemically for the concentration of estrogen and progesterone receptors. In the formalin-fixed and paraffin embedded group only 37% of the samples were estrogen receptor positive whereas 63% were receptor negative. In contrast, we found that 67% of the samples had a positive progesterone receptor status. In the fresh frozen group 60% of endometriotic tissues were estrogen receptor positive and 75% of the tissues had a positive progesterone receptor status. We could not find any correlation between the site or severity of the endometriosis or the hormonal receptor status. We were able to demonstrate that the immunohistochemical detection of hormonal receptors in endometriotic tissues is possible and that better results were obtained if fresh frozen rather than formalin-fixed and paraffin embedded tissues were analyzed.
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Affiliation(s)
- P A Regidor
- Abteilung für Gynäkologie, insbesondere gynäkologische Onkologie, Zentrum für Frauenheilkunde, Universitätsklinik Essen, Germany
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43
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Donnez J, Nisolle M, Casanas-Roux F. Peritoneal endometriosis: two-dimensional and three-dimensional evaluation of typical and subtle lesions. Ann N Y Acad Sci 1994; 734:342-51. [PMID: 7978936 DOI: 10.1111/j.1749-6632.1994.tb21764.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- J Donnez
- Department of Gynecology, Catholic University of Louvain, Cliniques Universitaires St. Luc, Brussels, Belgium
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Ortega-Moreno J. Receptor concentrations for estradiol and progesterone in surgically induced endometriosis in the rat. Eur J Obstet Gynecol Reprod Biol 1994; 54:123-6. [PMID: 8070595 DOI: 10.1016/0028-2243(94)90250-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In order to obtain more detailed information about the validity of the rat as an endometriotic experimental model, endometriosis was surgically induced in 48 female Wistar rats, and the estrogen (ERc) and progesterone (PRc) receptor concentrations present in experimental endometriosis and endometrium were compared in the four estrous phases (n = 12). Lower values of ERc were found in endometriosis than in endometrium (proestrus, 156.27 +/- 24.09 vs. 195.27 +/- 32.13 pmol/g tissue, P < 0.05; estrus, 302.33 +/- 45.16 vs. 335.67 +/- 44.82 pmol/g tissue, P < 0.05; metestrus, 166.60 +/- 26.09 vs. 193.30 +/- 22.04 pmol/g tissue, P < 0.05; diestrus, 130.27 +/- 20.58 vs. 135.81 +/- 16.25 pmol/g tissue, P > 0.05; Student's t-test). As in the case of ERc, lower PRc were observed in endometriotic than in endometrial tissues (proestrus, (proestrus, 137.83 +/- 22.64 vs. 176.54 +/- 21.78 pmol/g tissue, P < 0.05; estrus, 242.10 +/- 34.78 vs. 286.20 +/- 31.74 pmol/g tissue, P < 0.05; metestrus, 194.36 +/- 35.08 vs. 224.73 +/- 20.21 pmol/g tissue, P < 0.05; diestrus, 147.72 +/- 26.21 vs. 147.33 +/- 22.65 pmol/g tissue, P > 0.05; Student's t-test). Similar ERc/PRc ratios were found for both the endometriotic and the endometrial tissues (proestrus, 1.14 +/- 0.07 vs. 1.08 +/- 0.09, P > 0.05; estrus, 1.29 +/- 0.19 vs. 1.21 +/- 0.18, P > 0.05; metestrus, 0.87 +/- 0.14 vs. 0.89 +/- 0.11 P > 0.05; diestrus, diestrus, 0.89 +/- 0.06 vs. 0.92 +/- 0.06, P > 0.05; Student's t-test, NS).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J Ortega-Moreno
- Department of Animal Pathology, University of Zaragoza, Spain
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45
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Yamamoto T, Noguchi T, Tamura T, Kitawaki J, Okada H. Evidence for estrogen synthesis in adenomyotic tissues. Am J Obstet Gynecol 1993; 169:734-8. [PMID: 8372890 DOI: 10.1016/0002-9378(93)90654-2] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To investigate steroidogenesis in eutopic and ectopic endometrial tissues in adenomyosis. STUDY DESIGN Aromatase and estrone sulfatase activities were determined by anion-exchange resin column chromatography, thin-layer chromatography, and cocrystallization. The effects of danazol on the activity of these enzymes were also examined. Moreover, localization of aromatase in eutopic and ectopic endometrial tissues was immunohistochemically examined with antihuman placental aromatase cytochrome P-450 antibody. RESULTS Aromatase and estrone sulfatase activities were detected in ectopic endometrium. The activity of these enzymes was significantly suppressed by danazol. In addition, aromatase was immunohistochemically detected in glandular cells of eutopic and ectopic endometrial tissues. CONCLUSIONS The results suggest that estrogen is synthesized in the eutopic and ectopic endometrial tissues of women with uterine adenomyosis and that it may affect the growth of adenomyosis. Danazol suppressed synthesis of estrogen in vitro.
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Affiliation(s)
- T Yamamoto
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Japan
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Bergqvist A, Fernö M. Estrogen and progesterone receptors in endometriotic tissue and endometrium: comparison according to localization and recurrence**Supported by grant B91-17X-09511-01A from the Swedish Medical Research Council, Stockholm; by the Medical Faculty, University of Lund, and the John and Augusta Persson Foundation, Lund; and by the Malmö General Hospital Foundation, and the Malmö General Hospital Cancer Foundation, Malmö, Sweden. Fertil Steril 1993. [DOI: 10.1016/s0015-0282(16)56037-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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47
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Affiliation(s)
- P Mangtani
- Department of Epidemiology and Population Sciences, London School of Hygiene and Tropical Medicine
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48
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Nelson JR, Corson SL. Long-term management of adenomyosis with a gonadotropin-releasing hormone agonist: a case report. Fertil Steril 1993; 59:441-3. [PMID: 8425643 DOI: 10.1016/s0015-0282(16)55704-5] [Citation(s) in RCA: 86] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Leuprolide acetate was used to produce a constant hypoestrogenic environment in a young patient with histologically confirmed adenomyosis. Conservative medical therapy was initiated because of the patient's complaint of severe dysmenorrhea coupled with her strong desire for uterine conservation. The initial daily subcutaneous dose was eventually converted to monthly intramuscular depot formulation for patient convenience. A dramatic therapeutic response was observed with each course of therapy. This included a marked reduction in uterine size, amenorrhea, and complete resolution of pelvic pain. Cyclic use of an OC agent following LA was associated with a return of symptoms and uterine growth. The patient did, in fact, conceive immediately on cessation of analogue therapy.
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Affiliation(s)
- J R Nelson
- Pennsylvania Hospital, Department of Obstetrics and Gynecology, Pennsylvania
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49
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DePriest PD, Banks ER, Powell DE, van Nagell JR, Gallion HH, Puls LE, Hunter JE, Kryscio RJ, Royalty MB. Endometrioid carcinoma of the ovary and endometriosis: the association in postmenopausal women. Gynecol Oncol 1992; 47:71-5. [PMID: 1427405 DOI: 10.1016/0090-8258(92)90079-x] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Histologic material from 42 patients with endometrioid carcinomas of the ovary was reviewed. Ovarian endometriosis was present in 11 cases (26%) and 8 of these patients were postmenopausal. The exact site of transition from benign to malignant epithelium was observed in 4 cases. The clinical characteristics of patients with associated endometriosis were not significantly different from those without this finding except that endometriosis was present only in patients with Grade 1 or Grade 2 carcinomas. These data suggest that ovarian endometriosis in the postmenopausal patient has the potential to undergo malignant transformation and, when detected, should be removed surgically.
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Affiliation(s)
- P D DePriest
- Department of Obstetrics and Gynecology, University of Kentucky Medical Center, Lexington 40536
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50
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Brenner RM, McClellan MC, West NB, Novy MJ, Haluska GJ, Sternfeld MD. Estrogen and progestin receptors in the macaque endometrium. Ann N Y Acad Sci 1991; 622:149-66. [PMID: 2064178 DOI: 10.1111/j.1749-6632.1991.tb37859.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- R M Brenner
- Division of Reproductive Biology and Behavior, Oregon Regional Primate Research Center, Beaverton 97006
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