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Is abnormal eutopic endometrium the cause of endometriosis? The role of eutopic endometrium in pathogenesis of endometriosis.

Liu H, Lang JH - Med. Sci. Monit. (2011)

Bottom Line: Endometriosis (EM) is one of the most common diseases which severely affect the health and reproductive function of women of childbearing age.There are fundamental abnormal changes within the eutopic endometrium of women with endometriosis compared to normal endometrium of women without endometriosis.Eutopic endometrium shows enhanced ability of proliferation, implantation and angiogenesis, and greater probability of escaping the unfavorable conditions of the ectopic environment.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, PR China.

ABSTRACT
Endometriosis (EM) is one of the most common diseases which severely affect the health and reproductive function of women of childbearing age. There are fundamental abnormal changes within the eutopic endometrium of women with endometriosis compared to normal endometrium of women without endometriosis. Eutopic endometrium shows enhanced ability of proliferation, implantation and angiogenesis, and greater probability of escaping the unfavorable conditions of the ectopic environment. Therefore, the character of eutopic endometrium determines the fate of the backward-flowing endometrial tissue - to live or to die. The abnormal endometrial tissue in EM patients flows backward to the pelvic cavity, completing a 3-step procedure of pathogenesis (attachment-aggression-angiogenesis), and ultimately develops into EM. Abnormal eutopic endometrium may also play important roles in endometriosis-associated infertility. This recognition regarding the pathogenesis of endometriosis ultimately will help to discover new methods for diagnosis and treatment. Endometrial markers for micro-invasive diagnosis and direct treatment of eutopic endometrium as the origin of the disease should be further investigated.

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Simplified view of role of eutopic endometrium in pathogenesis of endometriosis(up arrow) and its clincal implications(down arrow). sICAM, soluble intercellular adhesion molecule-1. FasL, Fas ligand. Treg cells, regulatory T lymphocytes. MMPs, matrix metalloproteinases. uPA, urokinase-type plasminogen activator. uPAR, uPA receptor. VEGF, vascular endothelial growth factor. VEGFR, VEGF receptor. HER, human epidermal growth factor receptor. LNG-IUS, levonorgestrel intrauterine system.
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f1-medscimonit-17-4-ra92: Simplified view of role of eutopic endometrium in pathogenesis of endometriosis(up arrow) and its clincal implications(down arrow). sICAM, soluble intercellular adhesion molecule-1. FasL, Fas ligand. Treg cells, regulatory T lymphocytes. MMPs, matrix metalloproteinases. uPA, urokinase-type plasminogen activator. uPAR, uPA receptor. VEGF, vascular endothelial growth factor. VEGFR, VEGF receptor. HER, human epidermal growth factor receptor. LNG-IUS, levonorgestrel intrauterine system.

Mentions: Even though the underlying mechanisms that lead to the development and maintenance of endometriosis are still an enigma, numerous data indicate that eutopic endometrial glandular and stromal cells may be functioning differently in women with endometriosis compared to normal endometrium in disease-free women. These cells have intrinsic characteristics that favor their survival outside the uterine cavity and precede development of well-documented changes at the peritoneum and other ectopic sites [84]. During menstruation, the sloughing endometrial cells in endometriosis patients could escape immune surveillance from the body and are less susceptible to apoptosis, resulting in an increase in viable cells. After overcoming a phase of immune tolerance, the next step in the development of early endometriosis is the adhesion of endometrial cells to mesothelium and invasion of the extracellular matrix, since the eutopic endometrium of women with endometriosis are more adhesive and invasive then normal endometrium. After the last step of angiogenesis, the endometrial cells establish a new blood supply for the survival of implants, continue to proliferate in ectopic sites, and finally result in endometriosis (Figure 1). During this process of disease development, multiple factors in both the general and local environments have important roles in facilitating the development and maintenance of the disease. Many differences observed between eutopic endometrium and ectopic tissue of patients with endometriosis can be explained as the direct consequence of a different environment. However, this hypothesis may only apply to peritoneal endometriosis but not to endometrioma and deep endometriosis lesions, because the pathogeneses of endometriosis are different in different lesions [85].


Is abnormal eutopic endometrium the cause of endometriosis? The role of eutopic endometrium in pathogenesis of endometriosis.

Liu H, Lang JH - Med. Sci. Monit. (2011)

Simplified view of role of eutopic endometrium in pathogenesis of endometriosis(up arrow) and its clincal implications(down arrow). sICAM, soluble intercellular adhesion molecule-1. FasL, Fas ligand. Treg cells, regulatory T lymphocytes. MMPs, matrix metalloproteinases. uPA, urokinase-type plasminogen activator. uPAR, uPA receptor. VEGF, vascular endothelial growth factor. VEGFR, VEGF receptor. HER, human epidermal growth factor receptor. LNG-IUS, levonorgestrel intrauterine system.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3539524&req=5

f1-medscimonit-17-4-ra92: Simplified view of role of eutopic endometrium in pathogenesis of endometriosis(up arrow) and its clincal implications(down arrow). sICAM, soluble intercellular adhesion molecule-1. FasL, Fas ligand. Treg cells, regulatory T lymphocytes. MMPs, matrix metalloproteinases. uPA, urokinase-type plasminogen activator. uPAR, uPA receptor. VEGF, vascular endothelial growth factor. VEGFR, VEGF receptor. HER, human epidermal growth factor receptor. LNG-IUS, levonorgestrel intrauterine system.
Mentions: Even though the underlying mechanisms that lead to the development and maintenance of endometriosis are still an enigma, numerous data indicate that eutopic endometrial glandular and stromal cells may be functioning differently in women with endometriosis compared to normal endometrium in disease-free women. These cells have intrinsic characteristics that favor their survival outside the uterine cavity and precede development of well-documented changes at the peritoneum and other ectopic sites [84]. During menstruation, the sloughing endometrial cells in endometriosis patients could escape immune surveillance from the body and are less susceptible to apoptosis, resulting in an increase in viable cells. After overcoming a phase of immune tolerance, the next step in the development of early endometriosis is the adhesion of endometrial cells to mesothelium and invasion of the extracellular matrix, since the eutopic endometrium of women with endometriosis are more adhesive and invasive then normal endometrium. After the last step of angiogenesis, the endometrial cells establish a new blood supply for the survival of implants, continue to proliferate in ectopic sites, and finally result in endometriosis (Figure 1). During this process of disease development, multiple factors in both the general and local environments have important roles in facilitating the development and maintenance of the disease. Many differences observed between eutopic endometrium and ectopic tissue of patients with endometriosis can be explained as the direct consequence of a different environment. However, this hypothesis may only apply to peritoneal endometriosis but not to endometrioma and deep endometriosis lesions, because the pathogeneses of endometriosis are different in different lesions [85].

Bottom Line: Endometriosis (EM) is one of the most common diseases which severely affect the health and reproductive function of women of childbearing age.There are fundamental abnormal changes within the eutopic endometrium of women with endometriosis compared to normal endometrium of women without endometriosis.Eutopic endometrium shows enhanced ability of proliferation, implantation and angiogenesis, and greater probability of escaping the unfavorable conditions of the ectopic environment.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, PR China.

ABSTRACT
Endometriosis (EM) is one of the most common diseases which severely affect the health and reproductive function of women of childbearing age. There are fundamental abnormal changes within the eutopic endometrium of women with endometriosis compared to normal endometrium of women without endometriosis. Eutopic endometrium shows enhanced ability of proliferation, implantation and angiogenesis, and greater probability of escaping the unfavorable conditions of the ectopic environment. Therefore, the character of eutopic endometrium determines the fate of the backward-flowing endometrial tissue - to live or to die. The abnormal endometrial tissue in EM patients flows backward to the pelvic cavity, completing a 3-step procedure of pathogenesis (attachment-aggression-angiogenesis), and ultimately develops into EM. Abnormal eutopic endometrium may also play important roles in endometriosis-associated infertility. This recognition regarding the pathogenesis of endometriosis ultimately will help to discover new methods for diagnosis and treatment. Endometrial markers for micro-invasive diagnosis and direct treatment of eutopic endometrium as the origin of the disease should be further investigated.

Show MeSH
Related in: MedlinePlus