A potential indicator of invasive endometriosis. 

The protein encoded by ZEB1 gene (Zinc finger E-box-Binding homeobox) may be a potential indicator of invasive endometriosis.

Key Points

Highlights: 

• The protein encoded by ZEB1 gene (Zinc finger E-box-Binding homeobox) may be a potential indicator of invasive endometriosis and its action may be related to its epithelial-mesenchymal transition properties.

Importance: 

• ZEB1 is a transcription factor that has been implicated in the malignant progression of tumors, such as lung cancers.
• Deep infiltrating endometriosis (DIE) is strongly associated with severe chronic pelvic pain, dyspareunia (painful sexual intercourse) and menstrual cramps.
• DIE is defined as endometriotic implants that penetrate the retroperitoneal space more than 5 mm. and have some features of malignancy such as invasion and dissemination.
• Epithelial-mesenchymal transition (EMT) is the process that epithelial cells gain migratory and invasive properties by stemness features and ZEB1 is one of the regulators.
• The preferential expression of ZEB1 in DIE may suggest ZEB1 may act through EMT and it can be a potential indicator of invasiveness or severity of endometriosis.

Key Results: 

• Normal endometrium did not express ZEB1 and a statistically significant difference in ZEB1 expression were observed between normal endometria and endometriosis.
• ZEB1 expression was correlated with serum CA125 levels of the patient.

What’s done here?

• Endometriosis tissues from 13 women who underwent surgery for endometriosis were examined (6 ovarian endometriomas, 6 adenomyosis, and 5 deep infiltrating endometriosis; normal endometrium from 10 women was used as controls.
• ZEB1 expression, E-cadherin expression, and serum CA125 levels were compared.

Limitations of the study:

• The sample size is small.
• Serum CA125 levels may not be a clear indicator if deep infiltrating endometriosis.             

Lay Summary

Furuya & Masuda et al., in their recent article that will be published in Acta Obstet Gynecol Scand, report that the protein encoded by ZEB1 gene (Zinc finger E-box-Binding homeobox) is a potential indicator of invasive endometriosis.  ZEB1 is a transcription factor that has been implicated in the malignant progression of tumors, such lung cancers.  Endometriotic implants that penetrate the retroperitoneal space more than 5 mm are defined as "deeply infiltrating endometriosis" and strongly associated with severe chronic pelvic pain, dyspareunia (painful sexual intercourse) and menstrual cramps.

The process that epithelial cells gain migratory and invasive properties by stemness features is called Epithelial-Mesenchymal Transition (EMT). ZEB1 is one of the regulators of EMT.

Endometriosis tissues from 13 women who underwent surgery for endometriosis were examined including ovarian endometriomas (n=6), adenomyosis (n=6), and deep infiltrating endometriosis (n=5); and normal endometrium from 10 women underwent surgery for Endometriosis reasons other than endometriosis were used as controls. A statistically significant difference in ZEB1 expression was observed between normal endometria and endometriosis. Additionally, ZEB1 was most frequently observed in epithelial cells of invasive endometriosis. The endometriosis patients with high serum CA125 level were more likely to have ZEB1-positive lesions.

This study demonstrated that ZEB1 was highly expressed in endometriosis. As normal endometrium did not express this protein, the preferential expression of ZEB1 in DIE may suggest ZEB1 may act through EMT and it can be a potential indicator of invasiveness or severity of endometriosis.  Further studies will clarify better concerning its relationship with invasion and dissemination.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/28597474