Pathogenesis of Endometriosis: New Insights into Prospective Therapies

Kapoor, Richa; Stratopoulou, Christina Anna; Dolmans, Marie-Madeleine

doi:10.3390/ijms222111700

Cited by 70 publications

(84 citation statements)

References 74 publications

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“…It is defined as the abnormal implantation of the endometrium outside the uterine cavity, particularly in the ovaries and pelvic peritoneum [3,4]. The colonization and growth of ectopic endometrium can result in chronic pelvic pain, infertility, dysmenorrhea, and other clinical symptoms in endometriosis patients [3,4]. Increased inflammatory responses in ectopic endometrial tissues are believed to be strongly associated with the pathogenesis of endometriosis, which is induced by the activation of proinflammatory factors and signaling pathways, as well as the increased infiltration of immune cells [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

“…Endometriosis is a benign gynecological disease that affects 6%-10% of reproductive-aged women and 20%-50% of women with infertility 1 , 2 . It is defined as the abnormal implantation of the endometrium outside the uterine cavity, particularly in the ovaries and pelvic peritoneum 3 , 4 . The colonization and growth of ectopic endometrium can result in chronic pelvic pain, infertility, dysmenorrhea, and other clinical symptoms in endometriosis patients 3 , 4 .…”

Section: Introductionmentioning

confidence: 99%

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An Update on the Multifaceted Role of NF-kappaB in Endometriosis

2022

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Endometriosis remains a common but challenging gynecological disease among reproductive-aged women with an unclear pathogenesis and limited therapeutic options. Numerous pieces of evidence suggest that NF-κB signaling, a major regulator of inflammatory responses, is overactive in endometriotic lesions and contributes to the onset, progression, and recurrence of endometriosis. Several factors, such as estrogen, progesterone, oxidative stress, and noncoding RNAs, can regulate NF-κB signaling in endometriosis. In the present review, we discuss the mechanisms by which these factors regulate NF-κB during endometriosis progression and provide an update on the role of NF-κB in affecting endometriotic cells, peritoneal macrophages (PMs) as well as endometriosis-related symptoms, such as pain and infertility. Furthermore, the preclinical drugs for blocking NF-κB signaling in endometriosis are summarized, including plant-derived medicines, NF-κB inhibitors, other known drugs, and the potential anti-NF-κB drugs predicted through the Drug-Gene Interaction Database. The present review discusses most of the studies concerning the multifaceted role of NF-κB signaling in endometriosis and provides a summary of NF-κB-targeted treatment in detail.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

An Update on the Multifaceted Role of NF-kappaB in Endometriosis

2022

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“…Iatrogenic endometriosis (IE) is defined by the appearance of endometrial glands and stroma outside the uterus following certain surgical procedures, including complete or supracervical hysterectomy, myomectomy, cesarean section, and the endometrial tissue seeding of surgical scars during these operations [ 1 ]. Cesarean scars such as skin and uterine scars, trocar insertion sites, sigmoid colon, ovaries, bladder, vaginal vault, and parietal peritoneum are the most prevalent locations for IE [ 2 , 3 ]. The transvaginal ultrasound examination is the first step in detecting endometriosis, since it is readily accessible, non-invasive, and reasonably inexpensive [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Challenges in Diagnosis and Prevention of Iatrogenic Endometriosis as a Long-Term Surgical Complication after C-Section

Neamtu

Dahma

Mocanu

et al. 2022

IJERPH

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Endometriosis is a gynecological condition caused by the development of endometrial tissue outside the uterine cavity. Naturally, it commonly occurs at locations such as the ovaries and pelvic peritoneum. However, ectopic endometrial tissue may be discovered outside of the typical sites, suggesting the possibility of iatrogenic seeding after gynecological operations. Based on this hypothesis, we developed a study aiming to establish the root cause of atypical implantation of endometrial foci, as the main end point, and to determine diagnostic features and risk factors for this condition, as a secondary target. The research followed a retrospective design, including a total of 126 patients with endometriosis who met the inclusion criteria. A group of 71 patients with a history of c-section was compared with a control group of patients with endometriosis and no history of c-section. Endometriosis that developed inside or in close proximity to surgical incisions of asymptomatic patients before surgical intervention was defined as iatrogenic endometriosis. Compared with patients who did not have a c-section, the c-section group had significantly more minimally invasive pelvic procedures and multiple adhesions and endometriosis foci at intraoperative look (52.1% vs. 34.5%, respectively 52.1% vs. 29.1%). The most common location for endometriosis lesions in patients with prior c-section was the abdominal wall (42.2% vs. 5.4%), although the size of foci was significantly smaller by size and weight (32.2 mm vs. 34.8 mm, respectively 48.6 g vs. 53.1 g). The abdominal wall endometriosis was significantly associated with minimally invasive pelvic procedures (correlation coefficient = 0.469, p-value = 0.001) and c-section (correlation coefficient = 0.523, p-value = 0.001). A multivariate regression analysis identified prior c-section as an independent risk factor for abdominal wall endometriosis (OR = 1.85, p-value < 0.001). We advocate for strict protocols to be implemented and followed during c-section and minimally invasive procedures involving the pelvic region to ensure minimum spillage of endometrial cells. Further research should be developed to determine the method of abdominal and surgical site irrigation that can significantly reduce the risk of implantation of viable endometrial cells. Understanding all details of iatrogenic endometriosis will lead to the development of non-invasive disease diagnosis and minimally invasive procedures that have the potential to reduce postoperative complications.

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“…There are three distinct forms of the disease (peritoneal, ovarian, and recto-vaginal endometriosis), each of them being associated with specific symptoms, although dysmenorrhea and chronic non-menstrual pelvic pain are the most prevalent [1]. The postulated origins of endometriotic lesions are retrograde menstruation, celomatic metaplasia, and lymphatic and vascular metaplasia [2]. Identifying the exact pathogenesis of endometriosis is challenging and contentious for gynecologists and reproduction specialists, endocrinologists, and researchers.…”

mentioning

confidence: 99%

“…In their manuscript, Kapoor et al [2] reviewed the biological key mechanisms responsible for inducing endometriosis and examine how their 'cross talk' favors disease development. Inflammation is one of the mechanisms that triggers endometriosis where cell proliferation and infiltration are implicated.…”

mentioning

confidence: 99%