Endometriose

Zusammenfassung Zwischen der Inzidenz der Endometriose und gesichertem Wissen über ihre Pathogenese besteht eine erstaunliche Diskrepanz. Viele Eigenschaften von Endometrioseherden sind noch ungeklärt oder erscheinen gar widersprüchlich. Experimentelle Daten zur Existenz von Stammzellpopulationen ín den Läsionen, vergleichbar mit dem Vorkommen von Stammzellen im eutopen Endometrium, bieten neue Interpretationsmöglichkeiten von Befunden zur Pathogenese. Darüber hinaus eröffnen sie gedankliche Perspektiven für zukünftige Therapieansätze. In Bezug auf den Ursprung der Stammzellen existiert die Annahme primär residenzieller Stammzellen neben Theorien zu einer möglichen Herkunft aus dem Knochenmark. Eng damit verbunden ist die Frage nach dem Umfang der Differenzierungspotenz dieser Stammzellen. Schließlich richtet sich der Blick auch auf die limitierte Fähigkeit somatischer Stammzellen zur Selbsterneuerung – eine Eigenschaft, die mit der „Erschöpfung“ der zyklischen Regenerationsfähigkeit von Endometrioseherden in Zusammenhang stehen und durchaus therapeutische Implikationen haben könnte. Abstract There is a surprising discrepancy between the incidence of endometriosis and facts about the pathogenesis of this highly frequent disease. Many features displayed by the lesions are not clear or are even contradictory. Experimental data on the occurrence of stem cell populations in the lesions and on the existence of stem cells in the eutopic endometrium offer new opportunities to explain the pathogenesis of the disease. Moreover, they can suggest new strategies for its therapy. As to the origin of these stem cells, two main possibilities are discussed. They may be either residential cells or derive from pluripotent bone marrow stem cells driven by hematogenic spread. Closely related to this question is the potential of the stem cells to differentiate. Finally, the limited ability of somatic stem cells for self renewal is an interesting focus of research into endometriosis which may explain limited abilities of the lesions themselves to regenerate cyclically. Similar content being viewed by others Literatur Steck T, Felberbaum R, Küpker W et al (2004) Endometriose. Springer, Wien New York. ISBN 3-211-00746-6 Gargett CE, Masuda H (2010) Adult stem cells in the endometrium. Mol Hum Reprod 16:818–834 Kao AP, Wang KH, Chang CC et al (2011) Comparative study of human eutopic and ectopic endometrial mesenchymal stem cells and the development of an in vivo endometriotic invasion model. Fertil Steril 95:1308–1315 Figueira PG, Abrão MS, Krikun G, Taylor HS (2011) Stem cells in endometrium and their role in the pathogenesis of endometriosis. Ann N Y Acad Sci 1221:10–17 Chang HL, Senaratne TN, Zhang L et al (2010) Uterine leiomyomas exhibit fewer stem/progenitor cell characteristics when compared with corresponding normal myometrium. Reprod Sci 17:158–167 Cervelló I, Mas A, Gil-Sanchis C et al (2011) Reconstruction of endometrium from human endometrial side population cell lines. PLoS One 6:e21221 Zhang WB, Cheng MJ, Huang YT et al (2012) A study in vitro on differentiation of bone marrow mesenchymal stem cells into endometrial epithelial cells in mice. Eur J Obstet Gynecol Reprod Biol 160:185–190 Chan RW, Ng EH, Yeung WS (2011) Identification of cells with colony-forming activity, self-renewal capacity, and multipotency in ovarian endometriosis. Am J Pathol 178:2832–2844 Maruyama T, Yoshimura Y (2012) Stem cell theory for the pathogenesis of endometriosis. Front Biosci (Elite Ed) 4:2854–2863 Tamura M, Fukaya T, Murakami T et al (1998) Analysis of clonality in human endometriotic cysts based on evaluation of X chromosome inactivation in archival formalin-fixed, paraffin-embedded tissue. Lab Invest 78:213–218 Yano T, Jimbo H, Yoshikawa H et al (1999) Molecular analysis of clonality in ovarian endometrial cysts. Gynecol Obstet Invest 47(Suppl 1):41–45 (Diskussion 46) Wu Y, Basir Z, Kajdacsy-Balla A et al (2003) Resolution of clonal origins for endometriotic lesions using laser capture microdissection and the human androgen receptor (HUMARA) assay. Fertil Steril 79(Suppl 1):710–717 Nabeshima H, Murakami T, Yoshinaga K et al (2003) Analysis of the clonality of ectopic glands in peritoneal endometriosis using laser microdissection. Fertil Steril 80:1144–1150 Jeong K, Lee S, Kim I, Kang JS (2012) Chromosomal aberrations detected by chromogenic in situ hybridization in abdominal wall endometriosis after cesarean section. Int J Gynecol Pathol 31:328–334 Xu B, Hamada S, Kusuki I et al (2011) Possible involvement of loss of heterozygosity in malignant transformation of ovarian endometriosis. Gynecol Oncol 120:239–246 Schoenmakers EF, Wanschura S, Mols R et al (1995) Recurrent rearrangements in the high mobility group protein gene, HMGI-C, in benign mesenchymal tumours. Nat Genet 10:436–444 Bol S, Wanschura S, Thode B et al (1996) An endometrial polyp with a rearrangement of HMGI-C underlying a complex cytogenetic rearrangement involving chromosomes 2 and 12. Cancer Genet Cytogenet 90:88–90 Medeiros F, Araujo AR, Erickson-Johnson MR et al (2010) HMGA1 and HMGA2 rearrangements in mass-forming endometriosis. Genes Chromosomes Cancer 49:630–634 Medeiros F, Wang X, Araujo AR et al (2012) HMGA gene rearrangement is a recurrent somatic alteration in polypoid endometriosis. Hum Pathol 43:1243–1248 Hapangama DK, Turner MA, Drury JA et al (2008) Endometriosis is associated with aberrant endometrial expression of telomerase and increased telomere length. Hum Reprod 23:1511–1519 Laser J, Lee P, Wei JJ (2010) Cellular senescence in usual type uterine leiomyoma. Fertil Steril 93:2020–2026 Markowski DN, Ahsen I von, Nezhad MH et al (2010a) HMGA2 and the p19Arf-TP53-CDKN1A axis: a delicate balance in the growth of uterine leiomyomas. Genes Chromosomes Cancer 49:661–668 Markowski DN, Bartnitzke S, Belge G et al (2010b) Cell culture and senescence in uterine fibroids. Cancer Genet Cytogenet 202:53–57 Markowski DN, Helmke BM, Belge G et al (2011) HMGA2 and p14Arf: major roles in cellular senescence of fibroids and therapeutic implications. Anticancer Res 31:753–761 Kato K (2012) Stem cells in human normal endometrium and endometrial cancer cells: characterization of side population cells. Kaohsiung J Med Sci 28:63–71 Interessenkonflikt Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht. Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Markowski, D., Küpker, W. & Bullerdiek, J. Endometriose. Gynäkologische Endokrinologie 10, 250–254 (2012). https://doi.org/10.1007/s10304-012-0483-9 Published: Issue date: DOI: https://doi.org/10.1007/s10304-012-0483-9