Serum Chemokines and Quality of Life among Patients with Endometriomas and Teratomas (original) (raw)
Related papers
Peritoneal fluid concentrations of β-chemokines in endometriosis
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2013
Endometriosis, defined by the presence of viable endometrial tissue outside the uterine cavity, is a common chronic inflammatory disease affecting 3-10% of women of reproductive age, and is associated with chronic pelvic pain and infertility. It is an enigmatic disease with unknown etiology and poorly understood pathogenesis. According to the most widely accepted theory, the pathogenesis of endometriosis is a consequence of the implantation of viable endometrial tissues in the pelvis via retrograde menstruation [1]. Although retrograde menstruation is a nearly universal phenomenon among cycling women, only in a subgroup of women will endometrial tissue implant and grow in the peritoneal cavity [2-5]. There is general agreement that endometriosis is a pelvic inflammatory process with altered function of immune-related cells in the peritoneal environment [6]. In particular, macrophages represent the predominant cells in the peritoneal fluid and could play an important role in the development of endometriosis. Immunological dysfunction observed in women with endometriosis may be either a causative agent or simply a result of the disease [7]. These immunological abnormalities may also be implicated in the clinical presentation of the disease, including infertility. The disease is associated with infertility: in addition to obstruction of fallopian tubes due to adhesions, chemokines produced by macrophages and endometriotic tissues induce other factors that negatively affect both sperm motility and embryo implantation [1,5,8]. Women with infertility suffer from endometriosis at a rate of 30-50% [9,10]. According to the American Society of Reproductive Medicine the
Reproductive Medicine
Women with endometriosis are often under stress due to the associated pain, infertility, inflammation-related and other comorbidities including cancer. Additionally, these women are also under stress due to taboos, myths, inter-personal troubles surrounding infertility and pain of the disease as well as due to frequent incidences of missed diagnosis and treatment recurrence. Often these women suffer from frustration and loss of valuable time in the prime phase of life. All these complexities integral to endometriosis posit a hyperstructure of integrative stress physiology with overt differentials in effective allostatic state in women with disease compared with disease-free women. In the present review, we aim to critically examine various aspects of pathophysiological basis of stress surrounding endometriosis with special emphasis on pain and subfertility that are known to affect the overall health and quality of life of women with the disease and promising pathophysiological basis...
Meeting the Challenges of Endometriosis Associated Pain-Newer Options for Future and Research Directions, 2017
role of Central Sensitization, Hormonaltherapy like GnRH Antagonist: GnRH Antagonists asinjections (cetrirelix, ganirelix)or oral nonapeptide forms (elagolix,abarelix,ozarelix,TAK-385),roles of Selective Estrogen Receptor Modulators: Raloxifene,Bazedoxifene(BZA), a 3rd generation SERM,Aromatase Inhibitors:in Non hormonal Treatment Immunomodulators-TNFα blocker (etanercept),infliximab (a monoclonal anti TNFαantibody,Romidepsin is a histone deacetylator (HDAC) inhibitor.dopaminergic agents like Cabergoline,Bentamapimod, is a c-Jun NH2 terminal kinase inhibitor (JNKI).are discussed for relief of EndometriosisAssociated Pain antibody)
Journal of Reproductive Immunology, 2010
Immunological changes and gene expression anomalies are involved in the etiopathophysiology of endometriosis, although how these alterations are connected is not well established. The aim of this study was to determine the relationship between levels of immune cell populations, cytokines and CA-125 in peritoneal fluid (PF) and ‘chocolate’ cyst fluid (CF), and aromatase expression in endometriotic tissue, as well as to investigate any association with symptoms or recurrence of the disease. Eutopic and ectopic endometrium, CF and PF were collected from 84 women with endometriomas and 24 with benign non-functioning ovarian tumors undergoing radical or conservative surgery. Immunohistochemistry was performed to determine aromatase expression. PF cell populations were assessed by flow cytometry, and CF and PF levels of interleukin (IL)-6, IL-8, IL-13, IL-17 and CA-125 were quantified by ELISA. These parameters were compared with aromatase expression, symptoms and recurrence of the disease. IL-6 levels in PF were higher in patients with endometriosis than in patients with benign non-functioning ovarian cysts, and correlated positively to dysmenorrhea and pelvic pain in the first group. An association between PF IL-8 and CA-125 was also observed in endometriosis. Aromatase positive patients showed higher levels of PF CA-125 and CF IL-17. Recurrence of symptoms or endometrioma occurred sooner in patients having higher IL-6 or IL-8 levels in CF, respectively. These findings suggest an association of IL-6 with pain in endometriosis, as well as a relationship between cytokine expression and recurrence of the disease. However no clear relationship between aromatase expression and other parameters was found.
Fertility and Sterility, 2012
Objective: To assess the relationship between endometriotic lesions with associated nerve fibers with both pain and peritoneal fluid (PF) cytokine concentrations based on lesion location. Design: An observational study. Setting: University hospital. Patient(s): Premenopausal women undergoing laparoscopy. Intervention(s): The pain experienced by patients was recorded before surgery and ectopic endometrial tissue excised and matching PF collected during laparoscopy. Immunohistochemistry was performed on endometriotic tissue sections to identify nerve fibers and PF cytokine concentrations determined. Main Outcome Measure(s): The pain experienced by women with endometriosis, the lesion locations, and the prevalence and proximity of nerve fibers to endometriotic lesions, as well as the PF concentrations of multiple cytokines. Result(s): Lesions from the rectovaginal septum were significantly more likely to be associated with a nerve fiber and report more menstrual pain than lesions from other regions. The PF glycodelin concentrations were also significantly higher in samples with an endometriotic-associated nerve. In peritoneal endometriotic lesions significantly more menstrual pain was reported when endometriotic lesions were associated with nerve fibers, although no difference was observed between the cytokine concentrations. Ovarian endometriotic lesions were rarely associated with nerve fibers. Conclusion(s): The presence of endometriosis-associated nerve fibers appear to be related to both the pain experienced by women with endometriosis and the concentration of PF cytokines; however, this association varies with the lesion location. (Fertil Steril Ò 2012;97:373-80.
Debilitating Pain of Endometriosis: Could Anti-Tumour Necrosis Factor Alpha Be a Saviour
Backgrounds: Endometriosis is a chronic, debilitating gynecological disorder causing pelvic pain, infertility, and emotional despair. Endometrial tissue production is based on estrogen provided by the ovaries and, thus, conventional management focuses on suppression of ovarian function. Current drug regimens are used to control the condition by causing the hypoestrogenism state. While this lack of circulating estrogen levels contribute to a regression of the disorder, this hypoestrogenicity often produces many negative and undesirable side effects. These drawbacks of existing drug therapies such as vaginal atrophy, dryness, bone loss, abnormalities in the lipid profile show their shortcomings and the need to produce new endometriosis treatments. The latest treatment for the medical management of endometriosis, and its limitations, is discussed in this review. Potential target areas that may be an enticing alternative to them also analyzed the conventional therapies and include aromatase inhibitors, gonadotropin-releasing hormone (GnRH) agonist, and tumor necrosis factor (TNF)-α inhibitors.
Chronic pelvic pain and endometriosis: translational evidence of the relationship and implications
Human Reproduction Update, 2010
† Introduction † Methods † Spectrum of pain and lesions † Effects of current treatments on pain associated with endometriosis † Neural mechanisms of pain in endometriosis † Potential therapies directed at neural involvement in pain † Neuroimmune and neuroendocrine factors † Contributions of the reproductive organs and functions † Problems with pain assessments in practice and in clinical studies † Summary, conclusions and future directions background: Many clinicians and patients believe that endometriosis-associated pain is due to the lesions. Yet causality remains an enigma, because pain symptoms attributed to endometriosis occur in women without endometriosis and because pain symptoms and severity correlate poorly with lesion characteristics. Most research and reviews focus on the lesions, not the pain. This review starts with the recognition that the experience of pain is determined by the central nervous system (CNS) and focuses on the pain symptoms. methods: Comprehensive searches of Pubmed, Medline and Embase were conducted for current basic and clinical research on chronic pelvic pain and endometriosis. The information was mutually interpreted by a basic scientist and a clinical researcher, both in the field of endometriosis. The goal was to develop new ways to conceptualize how endometriosis contributes to pain symptoms in the context of current treatments and the reproductive tract. results: Endometriotic lesions can develop their own nerve supply, thereby creating a direct and two-way interaction between lesions and the CNS. This engagement provides a mechanism by which the dynamic and hormonally responsive nervous system is brought directly into play to produce a variety of individual differences in pain that can, in some women, become independent of the disease itself. conclusions: Major advances in improving understanding and alleviating pain in endometriosis will likely occur if the focus changes from lesions to pain. In turn, how endometriosis affects the CNS would be best examined in the context of mechanisms underlying other chronic pain conditions.