Massarotti Claudia, Mirabelli Badenier Ilaria, Paudice Michele, Scaglione Giulia, Remorgida Valentino, Vellone Valerio Gaetano
Physiopathology of Human Reproduction Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy.
School of Medicine, University of Genova, Genova, Italy.
J Gynecol Obstet Hum Reprod. 2021 Mar;50(3):101861. doi: 10.1016/j.jogoh.2020.101861. Epub 2020 Jul 8.
A better characterization of steroid intracrine pathways in endometriosis lesions may lead to a better understanding of the pathogenesis of the disease and insights on the mechanism of resistance to medical therapy. The study aims to evaluate the expression of steroid receptors in endometriosis lesions, including for the first-time androgen receptors, both in glandular and stromal tissue, and to describe the differences, in any, in receptor expression in the different subtypes.
This is a retrospective analysis of 76 specimens from 51 women, that underwent laparoscopic surgery for endometriosis at a tertiary hospital between 2015 and 2019. Immunohistochemical detections of estrogen, progesterone and androgen receptors positive cells was performed and the results described in terms of both density and intensity. The density and intensity scores were combined to obtain a final Histological Score (HS). Non-parametric Kruskal-Wallis test or Mann-Whitney U-test were used to compare continuous data, chi square test for categorical data.
Estrogen receptor α expression was moderate/high in almost all specimens, regardless of the site. Samples from endometriomas presented lower progesterone receptor expression in the epithelium, compared to pelvic sites. Androgen receptor density was higher in stromal cells compared to epithelial cells and in pelvic sites compared to ovarian ones.
The roles of nuclear receptors in endometriosis, including differences in their expression, could help in defining the pathogenesis of the disease and in explaining different responsivity to therapies. The intracrine regulation of steroids plays a relevant role in the metabolic and inflammatory pathogenetic paths of endometriosis: if better understood, its manipulation could be a relevant therapeutic target for treatment.
更好地描述子宫内膜异位症病变中的类固醇内分泌途径，可能有助于更好地理解该疾病的发病机制，并深入了解对药物治疗产生耐药性的机制。本研究旨在评估类固醇受体在子宫内膜异位症病变中的表达，首次包括腺组织和基质组织中的雄激素受体，并描述不同亚型受体表达的差异（如有）。
这是一项对51名女性的76个标本进行的回顾性分析，这些标本于2015年至2019年在一家三级医院接受了子宫内膜异位症的腹腔镜手术。对雌激素、孕激素和雄激素受体阳性细胞进行免疫组织化学检测，并从密度和强度两方面描述结果。将密度和强度评分相结合以获得最终的组织学评分（HS）。使用非参数Kruskal-Wallis检验或Mann-Whitney U检验比较连续数据，使用卡方检验比较分类数据。
几乎所有标本中雌激素受体α的表达均为中度/高度，与部位无关。与盆腔部位相比，卵巢巧克力囊肿标本的上皮细胞中孕激素受体表达较低。与上皮细胞相比，基质细胞中的雄激素受体密度更高；与卵巢部位相比，盆腔部位的雄激素受体密度更高。
核受体在子宫内膜异位症中的作用，包括其表达差异，有助于明确该疾病的发病机制，并解释对治疗的不同反应性。类固醇的内分泌调节在子宫内膜异位症的代谢和炎症发病途径中起相关作用：如果能更好地理解，对其进行调控可能成为治疗的一个相关靶点。
