Hastings, J. M., & Fazleabas, A. T. (2003). Future directions in endometriosis research. Seminars in Reproductive Medicine, 21(2), 255-262. https://doi.org/10.1055/s-2003-41331
Hastings, Julie M., and Asgerally T. Fazleabas. "Future directions in endometriosis research." Seminars in Reproductive Medicine, vol. 21, no. 2, 2003, pp. 255-262.
Endometriosis depends on estrogen and involves the immune system
Endometriosis depends on estrogen, and the immune system appears to help lesions survive. Two researchers reviewed human, rodent and baboon studies in 2003. They discuss why the immune reaction does not clear refluxed tissue, whether later-stage lesions make their own estrogen, and why fertility is lowered. They outline directions for future research.
Key Findings
The authors state that endometriosis, the presence of a functional endometrium outside the uterine cavity, affects 5 million American women.
Approximately 90% of women experience reflux of menstrual tissue into the peritoneal cavity. In approximately 10% of menstruating women the refluxed tissue is not cleared and invades the peritoneal lining.
In the baboon, intraperitoneal autotransplantation of menstrual endometrium results in experimental endometriosis, which the authors say supports the theory of retrograde menstruation.
The authors write that the immune system plays an important role in the development of endometriosis, possibly at an early stage.
Women and baboons with endometriosis have lowered fecundity. Markers of uterine receptivity were absent from the uterine lining during the window of implantation in both.
Interpretation
This 2003 narrative review draws on cell, tissue and animal studies of endometriosis. The two authors work in a research lab. They note that most women already have established disease by the time they are seen. They describe the baboon model as a tool for studying the early, invasive stage of the disease. The findings support larger studies of the immune and hormone pathways that let the refluxed tissue survive and grow.
RRM Context
Restorative reproductive medicine looks for the cause of a disease and puts evaluation before treatment. The review describes related biology: some women fail to clear refluxed tissue, and later-stage lesions may make their own estrogen. The authors suggest that early diagnosis might let intervention therapies begin.
Our editorial summary of this paper, not the article's abstract.
Abstract
Endometriosis is an estrogen-dependent condition that affects 5 million American women; however, its etiology is not fully understood. The development of the baboon model of endometriosis provides an extremely powerful tool to investigate the development and progression of endometriosis from the early invasive phase to the advanced established disease. The inflammatory reaction that occurs in the peritoneal cavity at the site of endometriotic lesions does not clear the refluxed endometrial fragments. Moreover, this reaction appears to promote the survival of the tissue and the development of the disease. Exploration of the interactions between peritoneal macrophages and cytotoxic T cells and endometrial cells will determine whether their ability to scavenge and induce apoptosis is altered. Determining the mechanism(s) that induces the expression of estrogen and its receptor (ERbeta) is crucial to our understanding of the progression of the disease. The effects of ERbeta activation in endometriotic lesions should be investigated. It is important to determine the effects of estrogen on the function of the immune cells, either directly or indirectly. Finally, determining the effect of events at sites of ectopic endometrium on the eutopic endometrium may elucidate the mechanism(s) of infertility associated with endometriosis.
Endometriosis is a chronic inflammatory disease that drives pain, organ dysfunction, and infertility. How RRM-trained clinicians diagnose and treat it through excision surgery, cycle charting, and longitudinal care.
02mpq6x41 