The Importance of "uterine adenogenesis" in endometriosis development

Review study sheds light on the latest findings on different mechanisms in endometriosis pathogenesis

Key Points

Highlight:

• The adenogenetic factors, especially the alterations in the genes that take part in epithelial-mesenchymal interactions seem to play an important role in endometriosis pathogenesis.

Importance:

• Only through a thorough understanding of endometriosis's underlying mechanisms can improved therapies be developed, for ultimately enhancing the quality of life for affected women.

What’s done here:

• This is a review conducted by researchers from Italy aiming to assess the latest research findings on the recent developments around endometriosis pathogenesis.
• They performed a literature search and evaluated approximately 100 articles.
• They focused on the "adenogenesis-related factors" in the pathogenesis of the disease.

Key results:

• Elevated levels of FGF-23 and IFN-τ were observed in the endometriotic stroma, indicating potential involvement in vitamin D signaling and estrogen expression.
• GH, PRL-R, IGF-1, and IGF-2 were overexpressed in endometriotic tissues.
• Decreased levels of FGF-7 and FGF-10 were identified in endometriotic tissues.
• The findings suggest an embryogenetic theory in endometriosis pathogenesis.

Lay Summary

Understanding the complex pathogenetic mechanisms underlying endometriosis has been a big challenge. Several studies have demonstrated that the eutopic and ectopic endometrium exhibit distinct characteristics. Researchers led by Signorile et al. from Italy conducted a review of the recent developments in endometriosis pathobiology, touching on "endometrial adenogenesis" in particular. The article was published in the journal named In Vivo.

Upon a thorough literature search, approximately 100 articles were analyzed. The epidemiology, risk factors for endometriosis, and recent advances in diagnosis, imagining, and staging were summarized. The theories about the origin of endometriosis were discussed in detail. 

An emphasis was made on the role of “adenogenesis” in endometriosis which is the development of uterine glands. The gene products of the transcription factor genes that take part in uterine adenogenesis have been shown to be reduced in endometriotic lesions. While touching base on the importance of epithelial-mesenchymal interaction in endometriosis pathogenesis, the authors then talked about a previous study in which they compared immunohistochemical staining of various gene products between eutopic and ectopic endometrial glands and stroma.

Significant findings included elevated levels of FGF-23 and IFN-τ in the ectopic endometrial stroma compared to its eutopic counterpart, suggesting a link to vitamin D signaling and estrogen expression. What is more, GH, PRL-R, IGF-1, and IGF-2 were overexpressed in endometriotic tissues, implicating their roles in disease progression and disrupting the delicate balance of epithelial-mesenchymal interactions which are crucial for normal tissue development. Interestingly, growth factors like FGF-7 and FGF-10, crucial for endometrial morphogenesis, were found to be decreased in endometriosis, and this result was interpreted as possibly contributing to lesion formation. The authors state that these findings challenge the perception of endometriosis as solely estrogen-dependent, supporting an embryogenetic theory of its pathogenesis.

To conclude, despite various theories, a comprehensive explanation is lacking, highlighting the need for a deeper understanding of the endometriosis pathogenesis. The authors advocate for research focus on adenogenetic factors, emphasizing the importance of exploring multiple pathogenetic theories.

Research Source: https://pubmed.ncbi.nlm.nih.gov/37652504/