Fibrosis is not only a histological finding in endometriosis

New studies show that fibrosis might be related to several mechanisms in endometriosis pathophysiology

Key Points

Highlight:

• Fibrosis has been shown to be an active mechanism in endometriosis pathogenesis and could serve as a molecular hallmark.

Importance:

• As a result of chronic tissue injury, fibrosis may complicate the endometriotic lesions further during the management.
• New studies suggest it also has roles in the pathophysiology of endometriosis and should not be overlooked.

What’s done here:

• This is a reflection article aiming to show that fibrosis may be used as another molecular hallmark of endometriosis.

Key results

• Alpha-smooth muscle actin is useful in showing the activated myofibroblasts and it has been used as a marker in endometriotic lesions.
• Endometriotic lesions may lose their typical histological appearance of endometrial glands and stoma over time when they undergo fibrosis.
• Fibrosis was found to be positively correlated with the severity of dysmenorrhea and reduced AMH levels in patients with ovarian endometrioma.
• Transforming growth factor-b1, hyaluronan synthase 2, platelet-derived growth factor receptor, and several antifibrotic agents are among the candidates for reducing the effects of fibrogenesis in endometriosis patients.

Lay Summary

Endometriosis remains to be an active subject of research with its complex pathophysiology and the indistinct mechanisms that cause the proliferation and progression of the lesions. Besides the already known characteristics of the disease, there is strong evidence to support fibrosis as a molecular hallmark of the disease, and Dr. Burney from Washington, USA has shared his reflections on the importance of fibrosis in endometriosis. The article was published in the July 2022 issue of the journal Fertility and Sterility.

Fibrosis is an end result of chronic tissue injury and is the proliferation of fibrous connective tissue that is generated by myofibroblasts. The immunohistochemical stain a-smooth muscle actin is useful in showing the activated myofibroblasts and it has been used as a marker in endometriotic lesions.

Dr. Burney states it is important to know that endometriotic lesions may lose their typical histological appearance of endometrial glands and stoma over time when they undergo fibrosis and this results in inconstancies between the surgical prediagnosis and histopathological diagnosis.

A recent study showed that the extent of fibrosis was positively correlated with the severity of dysmenorrhea and reduced AMH levels in patients with ovarian endometrioma. The issue of increased cortical fibrosis and its relation to reduced AMH levels is an important area to investigate, Dr. Burney recommends, as it highlights follicle depletion in endometrioma patients which is an overlap of ovarian endometrioma and infertility.

Some candidates were discovered in animal studies that aim to diminish the effects of fibrogenesis in endometriosis patients, such as transforming growth factor-b1, hyaluronan synthase 2, platelet-derived growth factor receptor, and several antifibrotic agents.

Dr. Burney concludes by saying that rather than seeing fibrosis as only a complicating matter during the surgical management of endometriosis, physicians should be aware of the fact that fibrosis has a relationship with endometriosis-associated pain and infertility and that it might as well be a molecular hallmark in the disease pathogenesis.

Research Source: https://pubmed.ncbi.nlm.nih.gov/35624047/