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Background Brain-derived neurotrophic factor (BDNF) is a known regulator of the development and maintenance of chronic pain in various chronic disorders. Together with its high-affinity tyrosine kinase type B (TrKB) receptor, BDNF is extensively expressed in the mammalian female reproductive system. However, BDNF and TrKB expression in different stages of endometriosis and the relationship between the expression of each in ectopic lesions and endometriosis pain remain unclear. Methods Sixty-two women who underwent laparoscopic surgery were enrolled in this study: forty-six diagnosed with ovarian endometrioma (study group) and sixteen diagnosed with ovarian benign tumours (control group). Samples from eutopic endometrium and ovarian endometriotic lesions were obtained at laparoscopic surgery. BDNF and TrKB messenger RNA (mRNA) and proteins levels in the eutopic and ectopic endometrium of both groups were measured by real-time PCR and immunohistochemical staining, respectively. Before the surgery the visual analogue scale (VAS) was used to measure dysmenorrhoea. Results BDNF and TrKB expression levels were higher in ovarian endometriotic lesions than in eutopic endometrium and normal endometrium (P < 0.05), and there was no cyclical change. Furthermore, their expression levels were higher in eutopic endometrium than in normal endometrium (P < 0.05), and BDNF and TrKB levels were higher in stage IV ovarian endometriotic lesions than in stage II and III lesions (P < 0.05), with their expression being non-significantly higher in stage III than in stage II (P > 0.05). Additionally, correlation coefficients for the association analysis between the mRNA expression of BDNF or TrKB in eutopic endometrium and the dysmenorrhoea VAS score were r = 0.52 and r = 0.56 for BDNF and TrKB, respectively (P < 0.05). The correlation coefficients for the associations between BDNF and TrKB in both the eutopic and ectopic endometrium were r = 0.82 and r = 0.66, respectively (P < 0.05). Conclusions BDNF and TrKB are closely related to dysmenorrhoea caused by endometriosis and may be important in the pathobiology or pathophysiology of endometriosis.

Objectives: This study was anchored on the state of local immune-infiltration in the endometrium, which acts as critical factors affecting embryonic implantation, and aimed at establishing novel approaches to assess endometrial receptivity for patients with IVF failure.Methods: Immune-infiltration levels in the GSE58144 dataset (n=115) from GEO were analyzed by digital deconvolution and validated by immunofluorescence (n=30), illustrating that dysregulation of the ratio of Mf1 to Mf2 is an important factor contributing to implantation failure. Then, modules most associated with M1/M2 macrophages (Mfs) and their hub genes were then selected by weighted gene co-expression network and univariate analyses, then validated by GSE5099 macrophage dataset, qPCR analysis (n=16), and western blot. It revealed that closely related gene modules dominated three biological processes in macrophages: antigen presentation, interleukin−1−mediated signalling pathway, and phagosome acidification, respectively. Their hub genes were significantly altered in patients and related with ribosomal, lysosome, and proteasomal pathways. Finally, the artificial neural network (ANN) and nomogram models were established from hub genes, of which efficacy was compared and validated in the GSE165004 dataset (n=72). Models established by the selected hub genes exhibited excellent predictive values in both datasets, and ANN performed best with an accuracy of 98.3% and an AUC of 0.975 (95% CI 0.945-1). Conclusions: Macrophages, proven to be essential for endometrial receptivity, were regulated by gene modules dominating antigen presentation, interleukin−1−mediated signalling pathway, and phagosome acidification. Selected hub genes can effectively assess endometrial dysfunction receptivity for IVF outcomes by the ANN approach.