The Ritchie Centre, Hudson Institute of Medical Research, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.
Department of Obstetrics and Gynaecology, Monash University, Reproductive Medicine at Women's Health, Monash Health, Monash IVF, Melbourne, Victoria, Australia.
Semin Reprod Med. 2020 May;38(2-03):201-215. doi: 10.1055/s-0040-1713429. Epub 2020 Nov 11.
Endometriosis remains an enigmatic disease of unknown etiology, with delayed diagnosis and poor therapeutic options. This review will discuss the cellular, physiological, and genomic evidence of Sampson's hypothesis of retrograde menstruation as a cause of pelvic endometriosis and as the basis of phenotypic heterogeneity of the disease. We postulate that collaborative research at the single cell level focused on unlocking the cellular, physiological, and genomic mechanisms of endometriosis will be accompanied by advances in personalized diagnosis and therapies that target unique subtypes of endometriosis disease. These advances will address the clinical conundrums of endometriosis clinical care-including diagnostic delay, suboptimal treatments, disease recurrence, infertility, chronic pelvic pain, and quality of life. There is an urgent need to improve outcomes for women with endometriosis. To achieve this, it is imperative that we understand which cells form the lesions, how they arrive at distant sites, and what factors govern their ability to survive and invade at ectopic locations. This review proposes new research avenues to address these basic questions of endometriosis pathobiology that will lay the foundations for new diagnostic tools and treatment pathways.
子宫内膜异位症仍然是一种病因不明的神秘疾病，存在诊断延迟和治疗选择有限的问题。本综述将讨论 Sampson 经血逆流假说作为盆腔子宫内膜异位症病因的细胞、生理和基因组证据，以及该疾病表型异质性的基础。我们推测，在单细胞水平上开展合作研究，重点揭示子宫内膜异位症的细胞、生理和基因组机制，将伴随着针对子宫内膜异位症疾病独特亚型的个性化诊断和治疗方法的进步。这些进展将解决子宫内膜异位症临床护理中的临床难题，包括诊断延迟、治疗效果不佳、疾病复发、不孕、慢性盆腔疼痛和生活质量。迫切需要改善子宫内膜异位症患者的治疗效果。为了实现这一目标，我们必须了解哪些细胞形成病变，它们如何到达远处部位，以及哪些因素控制它们在异位部位存活和侵袭的能力。本综述提出了新的研究途径来解决这些子宫内膜异位症病理生物学的基本问题，为新的诊断工具和治疗途径奠定基础。
