Differential expression of interleukins (IL)-13 and IL-15 in ectopic and eutopic endometrium of women with endometriosis and normal fertile women

PROBLEM: Interleukins (IL) 13 and 15 are key regulators of inflammatory and immune responses, processes that are central to endometriosis and associated abnormalities. The present study examined (1) whether ectopic endometrial tissue expresses IL-13 and IL-15 (2) if their expression differs compared with matched eutopic endometrium and control endometrium from normal fertile women, and (3) if peritoneal fluids (PF) content of these cytokines reflects the disease compared with PF from women with peritoneal adhesions unrelated to endometriosis and those without pelvic pathology. METHODS: The expression of IL-13 and IL-15 mRNA and protein was determined using quantitative RT-PCR, ELISA and immunohistochemistry. RESULTS: Ectopic endometrium expresses IL-13 and IL-15 mRNA and protein with elevated levels compared with eutopic and control endometrium, irrespective of the phases of the menstrual cycle, with predominance in IL-13 expression. Endometrial epithelial cells were found to be the primary site of IL-13 and IL-15 expression. The PF content of IL-13 and IL-15 show a trend toward higher concentrations in women with adhesion and endometriosis, respectively, compared with fertile control without pelvic pathology. CONCLUSION: Interleukins 13 and 15 are expressed in ectopic endometrium and present in PF of women with endometriosis and their elevated expression in ectopic endometrium suggests that these cytokines play a key role in local inflammatory/immune responses that are critical in endometriosis-associated abnormalities.     

COX-2、VEGF以及MVD在子宫内膜异位症中的表达及意义

目的通过探讨环氧合酶-2（COX-2）、血管内皮生长因子（VEGF）以及微血管密度（MVD）在子宫内膜异位症（EMs）在位内膜、异位内膜及正常子宫内膜组织中的表达,探讨子宫内膜异位症的发病机制。方法采用免疫组化SP法检测EMs患者32例在位内膜、28例异位内膜及40例对照组正常子宫内膜中COX-2、VEGF的蛋白表达,计数微血管密度（MVD）值,并进行相关性分析。结果 （1）COX-2、VEGF在EMs在位内膜、异位内膜阳性表达率明显高于正常对照组,差异具有统计学意义（P〈0.05）,EMs异位内膜组COX-2、VEGF阳性表达率高于在位内膜组,差异有统计学意义（P〈0.05）。（2）MVD的计数在正常对照组,在位内膜组,异位内膜组依次递增,在位内膜组、异位内膜组与正常对照组比较有统计学差异（P〈0.05）,而在位内膜组与异位内膜组比较有统计学差异（P〈0.05）。（3）EMs在位内膜、异位内膜组患者和正常对照组COX-2蛋白表达与VEGF蛋白及MVD值的变化呈正相关。结论 COX-2与VEGF在EMs中的高表达,与子宫内膜异位的血管生成有关。     

GnRHⅡ蛋白在子宫内膜异位症患者中的表达及意义

目的：检测GnRHⅡ蛋白在子宫内膜异位症患者异位子宫内膜、在位子宫内膜和正常子宫内膜中的表达情况,同时分析其表达是否与子宫内膜月经周期有关。方法：采用免疫组织化学SP法检测GnRHⅡ蛋白在异位内膜、在位内膜及正常子宫内膜组织中的表达情况,并分析和比较其表达是否有差异。结果：GnRHⅡ蛋白在子宫内膜异位症患者异位、在位子宫内膜及正常子宫内膜中均有表达,阳性表达定位于子宫内膜腺体及间质细胞的细胞质;GnRHⅡ蛋白在异位内膜、在位内膜及对照组正常内膜的表达依次增强,两两比较差异有统计学意义（P＜0.05）;GnRHⅡ蛋白在正常子宫内膜分泌期表达强于增生期（P＜0.05）,且以分泌早中期最强,显著强于增生期和分泌晚期（P＜0.01）,而异位组或在位组的分泌期与增生期比较,差异无统计学意义（P＞0.05）。结论：GnRHⅡ蛋白在子宫内膜异位症的发病中以及在人类月经生理方面可能起重要作用。     

Vascular endothelial growth factor A and C gene expression in endometriosis

Angiogenesis is essential for the pathogenesis of endometriosis. Gene expression levels of vascular endothelial growth factor (VEGF) A and C in 10 eutopic endometrial, 23 normal peritoneal, and 62 endometriotic tissues surgically obtained from 47 women with endometriosis (group 2) were compared with those in 12 control eutopic endometrial and 9 normal peritoneal tissues from 15 women without endometriosis (group 1). VEGF-A mRNA expression levels in eutopic endometrium of group 2 were higher than those of group 1 throughout the menstrual cycle (P <0.01) and increased in the secretory phase. VEGF-A gene expression in peritoneal endometriotic lesion was statistically higher than that in normal peritoneum (P <0.01) and similar to that in eutopic endometrium of group 2. In contrast, gene expression levels of VEGF-C were relatively lower than those of VEGF-A in each lesion, and no cyclic variation was found. VEGF-A and C mRNA expression levels were significantly higher in ovarian endometriomas >6 cm in size than in those <6 cm in size. Immunohistochemical expression of VEGF-A and C was detected in the cytoplasm of glandular epithelial and stromal cells of ovarian endometrioma. These results suggest that endometriosis may arise from eutopic endometrium with higher levels of angiogenic activity possibly induced by VEGF-A in women with endometriosis. Moreover, VEGF-C as well as VEGF-A may be involved in the pathogenesis of ovarian endometrioma.     

Transcriptional expression of survivin and its splice variants in endometriosis

Survivin is a novel inhibitor of apoptosis (IAP), and the two splice variants of survivin (survivin-2B and survivin-EX3) have been identified. Gene expression levels of survivin, survivin-2B and survivin-EX3 in 56 ectopic (16 peritoneal red and 16 peritoneal black lesions and 24 ovarian endometriomata) and 13 eutopic endometrial tissues surgically obtained from 42 women with endometriosis (group A) were compared with those in 16 control eutopic endometrium from 16 women without endometriosis (group B) by quantitative RT-PCR analysis. Survivin mRNA expression levels in ectopic endometriotic tissues were significantly higher than those in eutopic endometrium of groups A and B over the whole cycle. Red peritoneal lesions had higher gene expression levels of survivin than black lesions. In contrast, all tissue samples examined showed relatively lower gene expression levels of survivin-2B and survivin-EX3. No cyclic variation was found in survivin and the two splice variants, both in ectopic and in eutopic endometrium. Although there was no significant difference in the ratio of survivin-2B/survivin between ectopic and eutopic endometrium, the ratio of survivin-EX3/survivin in peritoneal endometriotic lesions was significantly higher than that of eutopic endometrium of groups A and B. These results suggest that survivin and survivin-EX3 may be closely linked to escape from apoptosis and the development of endometriosis.     

Differential expression and localization of de-novo synthesized endometriotic haptoglobin in endometrium and endometriotic lesions

Endometriosis protein-I (ENDO-I) mRNA expression and protein localization were evaluated using in-situ hybridization and immunohistochemistry in endometriotic lesions and eutopic endometrium from women with endometriosis, and in eutopic endometrium from women without endometriosis (controls). When present, ENDO-I mRNA and protein were observed in the functionalis zone of endometrial stroma and the stroma of endometriotic lesions. Expression and localization differences were scored and statistically analysed. During the secretory stage, ENDO-I mRNA expression by endometriotic lesions and eutopic endometrium from women with disease was significantly greater than ENDO-I mRNA expression by proliferative stage eutopic endometrium from women with disease or eutopic endometrium from controls, regardless of cycle stage (P < 0.001). More ENDO-I protein was localized in endometriotic lesions and eutopic endometrium from women with disease than in eutopic endometrium from controls, regardless of cycle stage (P < 0.001). Differential expression and localization of ENDO-I may help develop minimally invasive diagnostic strategies for endometriosis. Further, as ENDO-I shares nucleotide sequence and amino acid sequence with hepatic haptoglobin-which in certain disease states is immunosuppressive and angiogenic-differences in ENDO-I expression and localization in the peritoneal cavity may contribute to the pathogenesis of endometriosis and/or facilitate development of unprecedented diagnostic or therapeutic approaches for management of this enigmatic disease.     

Expression of interleukin-8 receptors in endometriosis

BACKGROUND: Although the etiology of endometriosis is not well understood, chemokines and their receptors are believed to play a role in its pathogenesis. Therefore, we aimed to investigate the expression and localization of interleukin-8 (IL-8) receptors CXCR1 and CXCR2 in eutopic and ectopic endometrial tissues of women with endometriosis, and in endometrium of women without endometriosis. METHODS: Ectopic (n = 27) and homologous eutopic endometrium (n = 25) from women with endometriosis and endometrium from women without endometriosis (n = 27) were used for immunohistochemical analysis of CXCR1 and CXCR2. RESULTS: In normal endometrium, epithelial CXCR1 and CXCR2 immunostaining intensities were similar in the proliferative and secretory phase. Stromal CXCR1 expression was less then epithelial expression and did not show cyclical difference. No stromal CXCR2 expression was observed. In eutopic endometrium of women with endometriosis compared to endometrium of women without endometriosis, there was a significant increase in both proliferative and secretory phases for epithelial CXCR2 expression, and in proliferative phase for CXCR1 expression (P < 0.05). Both receptor immunoreactivities were significantly increased in the epithelial cells of ectopic endometrial tissues compared to that of normal endometrium (P < 0.05). CONCLUSIONS: These findings suggest that IL-8 and its receptors may be involved in the pathogenesis of endometriosis.     

Expression of angiogenic factors in endometriosis: relationship to fibrinolytic and metalloproteinase systems

BACKGROUND: Endometriosis is a highly prevalent, benign disease in which the angiogenic, fibrinolytic and metalloproteinase (MMP) systems may be implicated. The objective of this study is to analyse mRNA expression and protein levels of several angiogenic factors and to correlate them with several components of the fibrinolytic and MMP systems in samples from 71 women with endometriosis and 50 controls. METHODS AND RESULTS: Eutopic endometrium showed higher mRNA expression of vascular endothelial growth factor (VEGF) in patients than in controls. However, ovarian endometrioma had lower VEGF mRNA levels than did the eutopic endometrium of patients. Similar results were obtained for VEGF protein levels. On the other hand, a significant increase in thrombospondin-1 (TSP-1) levels was observed in ovarian endometrioma than in eutopic endometrium. The peritoneal fluid from women with endometriosis showed a significant increase in VEGF, urokinase-type plasminogen activator (uPA) and MMP-3 levels than that of controls. A significant correlation was observed between the levels of VEGF and uPA in endometrium and in peritoneal fluid. CONCLUSIONS: Endometrium and peritoneal fluid from women with endometriosis have increased levels of VEGF, uPA and MMP-3 levels. Therefore, the development of endometriotic implants at ectopic sites may be facilitated, promoting the progress of the endometriosis.     

Vascular endothelial growth factor (VEGF) in endometriosis

Angiogenesis is likely to be involved in the pathogenesis of endometriosis. According to the transplantation theory, when the exfoliated endometrium is attached to the peritoneal layer, the establishment of a new blood supply is essential for the survival of the endometrial implant and development of endometriosis. From the known angiogenic factors, vascular endothelial growth factor (VEGF) has emerged as a pivotally important regulator of normal angiogenesis and pathological neovascularization. The VEGF protein was evaluated immunohistochemically in the eutopic endometrium of 10 women without endometriosis (group I) at laparoscopy and the eutopic endometrium and peritoneal endometriotic lesions of 43 women with endometriosis (group II). VEGF histological scores were 9.7 +/- 4.3 and 4.0 +/- 2.6 respectively in the epithelium and stroma of the eutopic endometrium of group I women, and 10.3 +/- 2.3 and 3.6 +/- 2.3 respectively in women of group II. In red lesions, the VEGF scores were 11.1 +/- 3.0 in the epithelium and 5.1 +/- 3.0 in the stroma, and in black lesions were 8.6 +/- 2.7 and 1.6 +/- 1.6, respectively. Significantly lower values were observed in black lesions as compared with eutopic endometrium and red lesions, the values of which were similar. Scores were also evaluated according to the phase of the cycle. In eutopic as well as ectopic endometrium, no significant cyclic variations were observed throughout the cycle. However, VEGF content was found to be higher in the eutopic glandular epithelium of women with endometriosis during the late secretory phase, possibly suggesting a more likely tendency to implant. In contrast, significantly higher VEGF content was noted in red lesions as compared with black lesions. During all phases of the cycle, the VEGF content in stromal cells of red lesions was higher than in black lesions. Similarities in VEGF content were observed in the glandular epithelium of the eutopic endometrium of women with endometriosis and red lesions, suggesting that endometriosis probably arises from the peritoneal seeding of viable endometrial cells during retrograde menstruation and that red lesions can be considered as the first stage of implantation. After the attachment phase, the high VEGF levels could provoke an increase in the subperitoneal vascular network and facilitate implantation and viability in the retroperitoneal space. Lower VEGF levels in black lesions explain the decrease in both stromal vascularization, followed by fibrosis and inactivation of the implant.      

TGFβ1与EGFR在子宫内膜异位症中的表达及意义

目的检测转化生长因子β1（transforming growth factor beta 1,TGF-β1）以及表皮生长因子受体（epidermal growth factor receptor,EGFR）在子宫内膜异位症中的表达,探讨两者在子宫内膜异位症发生发展中的作用。方法采用免疫组织化学方法检测子宫内膜异位症患者在位内膜（10例）、异位内膜（10例）、正常子宫内膜（10例）中TGF-β1和EGFR的表达情况。结果TGF-β1在子宫内膜异位症异位内膜组中的表达显著高于子宫内膜异位症在位内膜组及对照组（P〈0.05）,TGF-β1在子宫内膜异位症在位内膜组及对照组中的表达无显著性差异（P〉0.05）;EGRF在子宫内膜异位症异位内膜组及在位内膜组中的表达显著低于对照组（P〈0.05）,EGFR在子宫内膜异位症异位内膜组及在位内膜组中的表达无显著性差异（P〉0.05）。结论TGF-β1及EGFR的异常表达可能与子宫内膜异位症的发生发展有关。     

Immunohistochemical characterization of proliferation, oestrogen receptor and progesterone receptor expression in endometriosis: comparison of eutopic and ectopic endometrium with normal cycling endometrium

Recent studies examining oestrogen and progesterone receptorstatus and the proliferative activity of endo-metriotic lesionshave produced conflicting reports. This study aimed to clarifythe receptor status and proliferative activity of eutopic andectopic endometrium from women with endometriosis and endometriumfrom normal women. Progesterone and oestrogen receptor expressionand proliferative activity were studied in eutopic and ectopicendometrium from 30 women with endometriosis and in endometriumfrom 30 normal cycling women using microwave-pretreated paraffin-embeddedsections stained with an avidin-biotin peroxidase technique.Progesterone and oestrogen receptor expression in the controlendo-metrium did not differ from that of eutopic endometriumfrom women with endometriosis. Oestrogen receptor expressionin ectopic endometrium increased from the proliferative to thelate secretory phase. Epithelial progesterone receptor expressiondecreased during the cycle. Oestrogen receptor expression inboth epithelium and stroma of ectopic endometrium was significantlyhigher than in eutopic endometrium throughout the cycle. Incontrast, stromal progesterone receptor expression tended tobe reduced in ectopic endometrium compared with eutopic tissue.Epithelial progesterone receptor expression was increased inectopic endometrium but only in the late secretory phase. Althoughproliferative activity in the epithelium of control and eutopicendometrium was reduced from the proliferative to the late secretoryphase, stromal activity did not vary. The proliferative activityin ectopic endometrium remained low and constant throughoutthe cycle. In the proliferative and early secretory phases,the proliferative activity of eutopic endometrium was increasedcompared with ectopic endometrium, but in the late secretoryphase, levels were comparable. These findings challenge previousreports which have suggested that oestrogen receptors are reducedin ectopic tissue. This may have clinical implications for thedevelopment of novel treatments for endometriosis.     

子宫内膜及异位灶趋化因子受体转录在子宫内膜异位症发病中的作用

目的：探讨子宫内膜异位症患者在位内膜及异位灶18种趋化因子受体的转录特征，以揭示趋化因子受体及其配体在子宫内膜异位症发生发展中的作用。方法：以正常子宫内膜为对照，半定量RT-PCR检测子宫内膜异位症患者在位内膜及异位灶18种趋化因子受体mRNA的表达水平，并比较其差异。结果：与正常子宫内膜相比，子宫内膜异位症患者在位子宫内膜CCR6、CCR8、CCR9、CX3CR1表达明显升高（P＜0．05）。与在位内膜相比，异位灶CCR4、CCR8、CCR9、CXCR1表达显著升高（P＜0．05）。结论：在位子宫内膜CCR6、CCR8、CCR9、CX3CR1高表达，可能参与子宫内膜异位症的发生；异位灶CCR4、CCR8、CCR9、CXCR1高表达，可能参与子宫内膜异位症的进一步发展。     

Increased leptin expression in endometriosis cells is associated with endometrial stromal cell proliferation and leptin gene up-regulation

Endometriosis is a polygenic disease with complex, multifactorial aetiologies affecting approximately 10% of women of reproductive age. Leptin is the product of the ob gene, which is related to reproductive function and immunological alteration. The angiogenic and mitogenic action of leptin may influence the formation of endometriosis. This study was aimed at determining whether leptin and leptin receptor expression differs in eutopic and ectopic endometria collected from laparoscopy and at investigating the pathophysiological role of leptin in the development of endometriosis. Leptin mRNA was undetectable in seven out of 14 eutopic endometria and only a minute amount was detected in the remaining samples. In contrast, there was a marked increase in leptin mRNA and protein expression in ectopic endometriotic lesions of patients with endometriosis (P < 0.05). Receptors for leptin were immunologically stained in eutopic endometrium as well as in ectopic endometriotic implants. However, the levels of mRNA for the long and total forms of leptin receptors were suppressed in association with the severity of endometriosis (P < 0.05). Administration of leptin stimulated its own mRNA expression in ectopic endometriotic stromal cells but decreased steady-state concentrations of mRNA encoding for leptin receptor (n = 6). In addition, leptin significantly enhanced both eutopic and ectopic endometrial stromal cell proliferation (P < 0.05). In conclusion, the differential distribution of mRNA for leptin and its receptor suggests an important autocrine and paracrine role for leptin in human endometriosis. The mitogenic and auto-augmentation effects of leptin may further contribute to the pathogenesis of endometriosis.     

生存素在子宫内膜异位症中的表达特点

目的 探讨生存素在子宫内膜异位症病灶及在位内膜中的表达情况及相关因素。方法 采用免疫组化抗生物素蛋白-过氧化物酶染色法（SP法）检测38例2002年12月至2004年9月在我院妇科住院的未经治疗的子宫内膜异位症患者的异位及在位内膜标本中生存素的表达，以同期因子宫肌瘤或宫颈病变接受手术的生育期妇女的子宫内膜作为对照。结果 病例组异位内膜与在位内膜均有生存素的表达并且缺乏周期性变化（P〉0．05），异位内膜腺上皮生存素表达的强度高于在位内膜（P〈0．05）。结论 子宫内膜异位症的异住及在位内膜均表达生存素，而且在位内膜间质及异住内膜腺上皮表达也缺乏周期性。     

组蛋白去乙酰化酶1在子宫内膜异位症中的表达及意义

目的 研究组蛋白去乙酰化酶1(HDAC1)在子宫内膜异位症患者在位及异位内膜中的表达,探讨其在子宫内膜异位症发生、发展中的作用. 方法 应用免疫组织化学和免疫印迹法检测20例子宫内膜异位症患者在位内膜和异位内膜组织(研究组)中及20例子宫肌瘤患者的子宫内膜组织(对照组)HDAC1的表达情况. 结果 HDAC1阳性着色主要分布于子宫内膜上皮细胞和间质细胞的细胞核,在位内膜中HDAC1的表达强度明显高于对照组子宫内膜(P<0.01).免疫印迹检测提示,子宫内膜异位症在位内膜和异位内膜组织中HDAC1蛋白的相对表达量分别为2.67±0.69和2.55±1.36,显著高于对照组子宫内膜1.63±0.93(P<0.01,P<0.05);而在位内膜组与异位内膜组之间无统计学差异(P＞0.05). 结论 HDAC1在子宫内膜异位症在位和异位内膜组织中的高表达,可能在子宫内膜异位症的发生、发展中起重要作用.     

子宫内膜异位症模型大鼠子宫内膜雌、孕激素受体表达的变化

利用大鼠子宫内膜异位症 (内异症 )动物模型 ,采用逆转录聚合酶链反应 (RT PCR)技术 ,检测子宫内膜雌激素受体 (ER)和孕激素受体 (PR)mRNAs的表达 ,探讨内异症的发病机理及激素治疗的可能性。结果表明 ,内异症模型组大鼠异位内膜ER、PRmRNAs的表达低于在位内膜及对照组正常子宫内膜 ,与后两者比较差异有显著性意义(P <0 0 1 ) ;而模型组在位内膜ER、PRmRNAs的表达与正常对照组比较差异无显著性意义。内异症模型组异位内膜ER PRmRNA比值大于在位内膜及正常子宫内膜ER PRmRNA比值 (P <0 0 1 )。提示内异症大鼠异位内膜ERmRNA表达的降低在内异症的发生与发展中起着一定的作用     

Evidence for an increased release of proteolytic activity by the eutopic endometrial tissue in women with endometriosis and for involvement of matrix metalloproteinase-9

BACKGROUND: For the implantation of endometrium in ectopic locations, remodelling of the extracellular matrix (ECM) is necessary. Many studies have shown an increased expression of various proteases in the ectopic endometrium of women with endometriosis. Few, however, have addressed possible changes in protease expression in the eutopic endometrium. METHODS AND RESULTS: Herein, we reveal an increased release of proteolytic activity by the eutopic endometrium of women with endometriosis compared with normal women (P < 0.01). Using zymography and western blotting, we identified matrix metalloproteinase (MMP)-2 and MMP-9 in the culture medium, and further found that MMP-9 secretion, as assessed by zymography and enzyme-linked immunosorbent assay (ELISA), was elevated in women with endometriosis compared with normal women (P < 0.05). No statistically significant difference in MMP-2 secretion between women with and without endometriosis was noted. However, a significant difference in the levels of the tissue inhibitor of metalloproteinases (TIMP)-1, a known MMP-9 inhibitor, was found (P < 0.05). CONCLUSION: The endometriosis-associated increase in proteolysis and imbalance between the secretion of MMP-9 and that of its natural inhibitor, TIMP-1, revealed in the culture medium of endometrial tissue may reflect in vivo the enhanced capacity of this tissue to break down the ECM in host tissues, thereby favouring its ectopic implantation and development.     

The expression profile of micro-RNA in endometrium and endometriosis and the influence of ovarian steroids on their expression

MicroRNAs (miRNAs), through mRNA degradation or repression, act as key regulator of gene expression. Our aim was to identify specific miRNAs that are expressed in endometrium of women with and without endometriosis. We profiled the expression of 287 miRNAs in paired eutopic and ectopic endometrium and isolated endometrial cells using microarray and validated the expression of selected miRNAs using real-time PCR. On the basis of global normalization, 65 of these miRNAs were identified to be expressed above the threshold levels set during the analysis in the endometrium of women without endometriosis with a progressive decline in expression in paired eutopic and ectopic endometrium. Statistical analysis (ANOVA) identified 48 of these miRNAs as differentially expressed among these tissues and 32 miRNAs between isolated endometrial stromal cell (ESC) and glandular epithelial cell (GEC) (P < 0.05). The expression of hsa-miR20a, hsa-miR21, hsa-miR26a, hsa-miR18a, hsa-miR206, hsa-miR181a and hsa-miR142-5p, predicted to target many genes, including TGF-betaR2, ERalpha, ERbeta and PR, respectively, was validated in these tissues and cells using real-time PCR. Treatment of ESC and GEC with 17beta-estradiol and medroxyprogesterone acetate (10(-8) M) differentially regulated the expression of hsa-miR20a, hsa-miR21 and hsa-miR26a, which in part reversed following co-treatment with ICI-182780 and RU-486 (10(-6) M), respectively (P < 0.05). In conclusion, we provided evidence for the expression of a number of differentially expressed miRNAs in eutopic/ectopic endometrium and isolated endometrial cells, opening up the possibility that aberrant/altered expression of some miRNAs whose expression is regulated by the ovarian steroids may influence the expression of specific target genes with central roles in normal endometrial cellular activities and pathogenesis of endometriosis.