Rahman Md Saidur, Kim Tae Hoon, Barrier Breton F, Spencer Thomas E, Kelleher Andrew M, Jeong Jae-Wook
Department of Obstetrics, Gynecology and Women's Health, University of Missouri School of Medicine, Columbia, Missouri, USA.
FASEB J. 2025 Mar 15;39(5):e70436. doi: 10.1096/fj.202403182R.
Endometriosis, characterized by the growth of uterine-like tissue outside the uterus, causes chronic pain and infertility. Current diagnostic and therapeutic strategies have notable limitations, including delayed diagnosis and adverse effects. The transcription factor forkhead box A2 (FOXA2), which is exclusively expressed in the uterine glandular epithelium, regulates key genes involved in endometrial proliferation, differentiation, fertility, and hormone response. While FOXA2 expression is reduced in the endometrial tissue of women with endometriosis, its pathophysiological role in the disease is not well understood. In this study, we report that endometriosis significantly reduced FOXA2 expression in the eutopic endometrium of mice with endometriosis compared to sham controls, accompanied by decreased expression of its downstream gene, CXCL15. To evaluate the effect of FOXA2 loss in endometriosis, we surgically induced endometriosis by transplanting control Rosa26 or PgrFoxa2Rosa26 (Foxa2Rosa26) endometrial tissue into the peritoneal cavity of mice. The number and weight of ectopic lesions were significantly increased in the mice with Foxa2Rosa26 ectopic lesions compared to controls. Furthermore, progesterone receptor expression was significantly reduced in the endometrial epithelium from mice with Foxa2Rosa26 ectopic lesions compared to mice with control ectopic lesions. Importantly, treatment with leukemia inhibitory factor (LIF), a cytokine regulated by FOXA2, significantly reduced ectopic lesion formation in Foxa2Rosa26 endometriosis mice compared to vehicle-treated mice. This study demonstrates that FOXA2 loss results in an increase in endometriosis incidence and that treatment with LIF offers a novel promising therapeutic approach for endometriosis.
子宫内膜异位症的特征是子宫外出现类似子宫的组织生长,会导致慢性疼痛和不孕。目前的诊断和治疗策略存在显著局限性,包括诊断延迟和不良反应。转录因子叉头框A2(FOXA2)仅在子宫腺上皮中表达,调节参与子宫内膜增殖、分化、生育和激素反应的关键基因。虽然子宫内膜异位症女性的子宫内膜组织中FOXA2表达降低,但其在该疾病中的病理生理作用尚不清楚。在本研究中,我们报告与假手术对照组相比,子宫内膜异位症显著降低了子宫内膜异位症小鼠在位子宫内膜中FOXA2的表达,同时其下游基因CXCL15的表达也降低。为了评估FOXA2缺失在子宫内膜异位症中的作用,我们通过将对照Rosa26或PgrFoxa2Rosa26(Foxa2Rosa26)子宫内膜组织移植到小鼠腹腔中手术诱导子宫内膜异位症。与对照组相比,具有Foxa2Rosa异位病变的小鼠异位病变的数量和重量显著增加。此外,与具有对照异位病变的小鼠相比,具有Foxa2Rosa异位病变的小鼠子宫内膜上皮中孕激素受体表达显著降低。重要的是,与载体处理的小鼠相比,用白血病抑制因子(LIF)(一种受FOXA2调节的细胞因子)治疗显著减少了Foxa2Rosa子宫内膜异位症小鼠的异位病变形成。这项研究表明,FOXA2缺失导致子宫内膜异位症发病率增加,并且用LIF治疗为子宫内膜异位症提供了一种新的有前景的治疗方法。