Endometriosis

Pathogenesis of endometriosis: the genetic/epigenetic theory

Endometriosis is one of the most common gynaecologic diseases in women of reproductive age. It is characterized by the presence of endometrial tissue outside the uterine cavity. The women affected suffer from pelvic pain and infertility. The complex etiology is still unclear and it is based on three main theories: retrograde menstruation, coelomic metaplasia, and induction theory. Genetics and epigenetics also play a role in the development of endometriosis. Recent studies have put the attention on the role of oxidative stress, defined as an imbalance between reactive oxygen species (ROS) and antioxidants, which may be implicated in the pathophysiology of endometriosis causing a general inflammatory response in the peritoneal cavity. Reactive oxygen species are intermediaries produced by normal oxygen metabolism and are inflammatory mediators known to modulate cell proliferation and to have deleterious effects. A systematic review was performed in order to clarify the different roles of oxidative stress and its role in the development of endometriosis. Several issues have been investigated: iron metabolism, oxidative stress markers (in the serum, peritoneal fluid, follicular fluid, peritoneal environment, ovarian cortex, and eutopic and ectopic endometrial tissue), genes involved in oxidative stress, endometriosis-associated infertility, and cancer development.

https://downloads.hindawi.com/journals/omcl/2017/7265238.pdf

Oxidative Stress and Endometriosis: A Systematic Review of the Literature

A double-blind cross-over sequential trial of a new antiallergic compound, disodium cromoglycate (' FPL670 ', ' Intal ') was carried out over a period of 6 weeks in ten patients severely disabled with allergic bronchial asthma. There was a significant clinical improvement during administration of FPL670 plus isoprenaline in all patients compared with two periods in which isoprenaline alone was given. Spirometric improvement occurred in only four patients. Subsequent experience over periods up to 26 months with these and other patients has confirmed the therapeutic value and safety of FPL670 in the management of allergic bronchial asthma.

A double-blind trial of disodium cromoglycate in the treatment of allergic bronchial asthma

Pathogenesis of deep endometriosis.

Oxidative stress in the pelvic cavity and its role in the pathogenesis of endometriosis.

Endometriosis remains a very enigmatic and perplexing disease. The exact mechanism by which endometriosis causes infertility is still unclear. In the present paper, we will review possible mechanisms leading to subfertility or infertility in women with endometriosis and examine them according to location. Endometriosis in the pelvic cavity is a pathology associated with a general inflammatory response and should therefore be considered an inflammatory disease. Inflammatory changes affect the peritoneal fluid and hence the intratubal milieu, since the ampulla (where fertilization takes place) is exposed to peritoneal fluid through the fimbria. Any inflammatory change at this level may therefore impact fertilization and natural conception. The relationship between ovarian endometriomas and infertility may, of course, be explained by the presence of periovarian endometriosis. In the ovary, fibrosis observed in some cortical areas is induced by the inflammatory reaction caused by the presence of endometriomas. The association between fibrosis and a reduced ovarian reserve was demonstrated. Upregulated recruitment and the subsequent demise of early follicles may result in focal exhaustion of primordial follicles. Burn-out of early follicles by a local pelvic inflammatory environment caused by endometriomas may therefore be suggested. However, intraovarian inflammation, subsequent fibrosis and depletion of the ovarian reserve constitute another reason that should also be given due consideration. In addition, surgery should not be ruled out as a possible cause of ovarian reserve depletion. In conclusion, potential mechanisms leading to infertility are numerous, and while some of them remain hypothetical for now, others are supported by clear evidence. These possible mechanisms were reviewed in the present paper.

Endometriosis and infertility.

Endometriosis is a chronic estrogen-dependent inflammatory disease of unclear etiology that affects 15-20% of women of reproductive age. Efforts are now focusing on understanding new mechanisms involved in its physiopathology, like novel target pathways and different molecules. There is evidence that mast cells (MCs) play a role in this disease. This article summarizes recent achievements in preclinical studies and clinical activities investigating the role of MCs in endometriosis. Targeting MCs might offer new alternatives to treat this disease. Areas covered: A systematic literature search was performed (PubMed, Cochrane Library and ClinicalTrials.gov) using the keywords 'endometriosis and mast cells'. All relevant articles (34) found in PubMed were examined and their reference lists reviewed in order to pinpoint further studies for potential inclusion. Expert opinion: Since endometriosis is a multifactorial disease, and considering that numbers of MCs and activated MCs were clearly increased in endometriotic lesions in both animals and humans, use of MC stabilizers and inhibitors may prove to be effective to treat endometriosis and its associated pain. However, more data from preclinical studies and clinical trials will help to better define the status of MCs in the treatment of this pathology.

Targeting mast cells: a new way to treat endometriosis.

Purpose
The aim of this study was to determine the best combination in terms of cryopreservation techniques and vascular bed preparation before grafting in order to obtain functional ovarian tissue after transplantation.

/pdf/impact-of-the-cryopreservation-technique-and-vascular-bed-on-2u3dpzy87q.pdf

Maria Mercedes Binda

Papers

Oxidative stress in the pelvic cavity and its role in the pathogenesis of endometriosis.

Endometriosis and infertility.

Targeting mast cells: a new way to treat endometriosis.

Impact of the cryopreservation technique and vascular bed on ovarian tissue transplantation in cynomolgus monkeys