Changes in endometrial receptivity in women with Asherman’s syndrome undergoing hysteroscopic adhesiolysis

Malhotra, Neena; Bahadur, Anupama; Kalaivani, Mani; Mittal, Suneeta

doi:10.1007/s00404-012-2336-0

Cited by 70 publications

(56 citation statements)

References 24 publications

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“…First, recurrence of uterine cavity adhesion after estrogen therapy is frequently observed, especially in severe IUA patients. 28 Second, the 17β-estradiol at high systemic levels may increase the risk for thrombosis and malignancy. 29 Third, by either oral delivery or systemic administration, 17β-estradiol always shows a low concentration at the injured uterus, which may reduce its therapeutic effect.…”

mentioning

confidence: 99%

Three-dimensional structure micelles of heparin-poloxamer improve the therapeutic effect of 17β-estradiol on endometrial regeneration for intrauterine adhesions in a rat model

Zhang¹,

Xia²,

Xu³

et al. 2017

IJN

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Intrauterine adhesions (IUA) frequently occur after infectious or mechanical injury to the endometrium, which may lead to infertility and/or pregnancy complications. There are few effective treatments due to the complex function of endometrium and shortage of native materials. 17β-estradiol (E 2 ) is commonly used as an ancillary treatment in IUA patients, but it is limited by its poor solubility in aqueous solutions and low concentrations at the injured sites. In this research, a mini-endometrial curette was used to injure the rat’s endometrium to form an IUA model. 17β-estradiol was encapsulated into the micelles of heparin-poloxamer and a thermosensitive hydrogel (E 2 -HP hydrogel) was formed. This sustained releasing system was applied to restore the structure and function of the injured uterus. E 2 -HP hydrogel was constructed and relevant characteristics including gelation temperature and micromorphology were evaluated. Sustained release of 17β-estradiol from HP hydrogel was performed both in vitro and in vivo. Ultrasonography measurement and pathologic characteristics on the IUA rats were performed to evaluate the therapeutic effect of E 2 -HP hydrogel. Endoplasmic reticulum (ER) stress-related apoptosis was analyzed to explore the possible mechanisms in IUA recovery. E 2 -HP hydrogel showed a prolonged release of E 2 at the targeting region and more effective endometrium regeneration in IUA rats. Significant improvements in both gland numbers and fibrosis area were observed in the E 2 -HP hydrogel group. We also demonstrated that E 2 -HP hydrogel in the recovery of IUA was closely related to the suppression of ER stress signals via the activation of downstream signals, PI3K/Akt and ERK1/2. HP hydrogel might be an effective approach to deliver E 2 into the injured endometrium. Therapeutic strategies targeting ER stress using E 2 -HP hydrogel might be a promising solution for the treatment of women with intrauterine adhesions.

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mentioning

confidence: 99%

Three-dimensional structure micelles of heparin-poloxamer improve the therapeutic effect of 17β-estradiol on endometrial regeneration for intrauterine adhesions in a rat model

Zhang¹,

Xia²,

Xu³

et al. 2017

IJN

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“…Endometrium in patients with abnormal fibrous connections containing vascular channels has poor receptivity [17]. UGL is expressed in epithelial cells, and one of the most important biological properties of UGL is its antiinflammatory effects [18,19].…”

Section: Discussionmentioning

confidence: 99%

Small Intestine Submucosa Is a Potential Material for Intrauterine Adhesions Treatment in a Rat Model

Kong

Zhang²,

Xu³

et al. 2017

Gynecol Obstet Invest

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Objective: To study whether small intestine submucosa (SIS) could be a treatment option for preventing the formation of intrauterine adhesions (IUAs). Methods: The IUAs model was established by mechanical curettage and infectious injury in a rat model. One uterine horn of the rat model was treated with the transplantation of SIS (SIS group) and the other one was left without any treatment (control group). The endometrium was evaluated with endometrial thickness, number of glands and fibrosis area. The endometrial receptive factors were detected by quantitative real-time polymerase chain reaction The number and location of embryos were documented to assess the function of endometrium. Results: In the SIS group, endometrial thickness was significantly thicker than that in the control group on the 14th and 21st day and the percentage of fibrosis area was significantly lower during the entire observation process (p < 0.05). The number of glands was similar between the 2 groups (p > 0.05). Receptive factors changed as follows: in the SIS group, the expression of uteroglobin was higher and peaked on the 21st day (3.42-fold, p < 0.05); the HOXA10 level was significantly higher on the 10th day (2.16-fold, p < 0.05), and it then decreased. More embryos were seen in SIS horns (5.13 vs. 1.25, p < 0.05). Conclusions: SIS could be a potential physical barrier for the formation of IUAs. It contributes to the regeneration of and improvement of the receptivity of endometrium, and helps in the implantation and development of embryos in a rat model.

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“…In women with severe IUA, endometrial cells exhibit some morphological changes including lost ribosomes, mitochondrial swelling, vascular closure and focal ischemic/hypoxic modifications [5,6]. Mitochondria are the main intracellular energy source for oxidative phosphorylation.…”

Section: Discussionmentioning

confidence: 99%

“…It has been shown that endometrial glandular cells from women with severe IUA exhibit sub-cellular modifications such as ribosome lost, mitochondria swelling, vascular closure and hypoxic cellular modifications [5]. Focal ischemic/hypoxic changes have also been demonstrated in the endometrium of women with IUA [6].…”

Section: Introductionmentioning

confidence: 99%

Mitochondrial DNA Haplogroup R Confers a Genetic Risk Factor for Intrauterine Adhesion in Han Women Population

Zhang

Zhu

Huang

et al. 2015

Gynecol Obstet Invest

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Background: To determine whether a specific mitochondrial DNA (mtDNA) haplogroup is implicated in the pathogenesis of intrauterine adhesion (IUA). Methods: Peripheral blood samples were collected from 486 women with (case group, n = 154) and without IUA (control group, n = 332) at the Women's Hospital, Zhejiang University School of Medicine. Genomic DNA was extracted from the blood, and the mtDNA haplogroups of Han women M, N and R were determined by sequencing hypervariable mtDNA segments and testing diagnostic polymorphisms in the mtDNA coding region. Results: Women with mtDNA haplogroup R had an independently increased genetic risk factor for IUA with an OR 1.77 (95% CI 1.16-2.70, p = 0.009) compared with women without. Moreover, repeated intrauterine surgery within 1 month and number of intrauterine operations were both significantly associated with IUA (p < 0.001). Conclusions: These results suggest that mtDNA haplogroup R, one of the main mtDNA haplogroups in Han population, is a strong independent genetic risk factor for women with IUA.

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Changes in endometrial receptivity in women with Asherman’s syndrome undergoing hysteroscopic adhesiolysis

Abstract: A significant improvement in the endometrial thickness was observed post-adhesiolysis. A high blood flow impedance of spiral artery perhaps impairs growth of the endometrium making it unsuitable for successful implantation.

Cited by 70 publications

References 24 publications

Three-dimensional structure micelles of heparin-poloxamer improve the therapeutic effect of 17β-estradiol on endometrial regeneration for intrauterine adhesions in a rat model

Three-dimensional structure micelles of heparin-poloxamer improve the therapeutic effect of 17β-estradiol on endometrial regeneration for intrauterine adhesions in a rat model

Small Intestine Submucosa Is a Potential Material for Intrauterine Adhesions Treatment in a Rat Model

Mitochondrial DNA Haplogroup R Confers a Genetic Risk Factor for Intrauterine Adhesion in Han Women Population

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Changes in endometrial receptivity in women with Asherman’s syndrome undergoing hysteroscopic adhesiolysis

Abstract: A significant improvement in the endometrial thickness was observed post-adhesiolysis. A high blood flow impedance of spiral artery perhaps impairs growth of the endometrium making it unsuitable for successful implantation.

Cited by 70 publications

References 24 publications

Three-dimensional structure micelles of heparin-poloxamer improve the therapeutic effect of 17&beta;-estradiol on endometrial regeneration for intrauterine adhesions in a rat model

Three-dimensional structure micelles of heparin-poloxamer improve the therapeutic effect of 17&beta;-estradiol on endometrial regeneration for intrauterine adhesions in a rat model

Small Intestine Submucosa Is a Potential Material for Intrauterine Adhesions Treatment in a Rat Model

Mitochondrial DNA Haplogroup R Confers a Genetic Risk Factor for Intrauterine Adhesion in Han Women Population

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Three-dimensional structure micelles of heparin-poloxamer improve the therapeutic effect of 17β-estradiol on endometrial regeneration for intrauterine adhesions in a rat model

Three-dimensional structure micelles of heparin-poloxamer improve the therapeutic effect of 17β-estradiol on endometrial regeneration for intrauterine adhesions in a rat model