Profilul molecular al endometrului eutopic şi ectopic în endometrioză

Endometriosis represents a chronic inflammatory disease defined by the appearance of endometrial tissue outside the uterine cavity, affecting mostly reproductive-aged wo­men. Although some patients may be asymptomatic, the clinical features of endometriosis are frequently do­mi­na­ted by pelvic pain associated with infertility. Non­spe­cific symptomatology and the lack of biological scre­ening markers with increased sensitivity and specificity lead to a slow diagnostic process. The hormonal profile of the eutopic and ectopic endometrium, molecular ab­nor­ma­li­ties and enzymatic mechanisms play a key role in the etiopathogenesis of endometriosis. Endometriotic im­plants are characterized by elevated levels of aromatase and 17β-HSD1 associated with low levels of 17β-HSD2 in response to low progesterone receptors, causing an in­­creased level of estradiol. It is characteristic a status of pro­ges­te­rone resistance, described by the inability of en­do­me­trial tissue to respond adequately to progesterone, the activation failure of progesterone receptors and the use of available progesterone. Endometriosis is defined by abnormal cell proliferation of ectopic endometrial tis­sue associated with apoptosis mechanisms disorders. The level of apoptotic cells is reduced in the epithelium and stroma of the eutopic endometrium and does not in­crease at the end of the secretory phase, compared to the nor­mal endometrium. Peritoneal endometriosis le­sions as­so­ciate elevated Bcl-2 levels, while ovarian en­do­me­trio­sis shows discordant results. The correlation between Ki-67 proliferation antigen level and the disease’s stage of evo­lu­tion and aggressiveness was confirmed by nu­me­rous stu­dies. The analysis of stem cells in the eu­to­pic en­do­me­trium of patients with endometriosis showed morphological chan­ges, altered expression of im­mu­no­mo­du­la­to­ry mo­le­cules and an increased potential for invasion and pro­li­fe­ra­tion. We believe that the characterization of the bio­che­mi­cal profile of the eutopic and ectopic endometrium is a current topic of interest in the understanding of en­do­me­trio­sis, its etiopathogeny and therapeutic approach. The main molecular features of ectopic endometrium pre­sent in endometriosis lesions are characterized by hy­per­es­tro­ge­ne­mia, progesterone resistance, a reduced apoptosis ca­pa­city, an increased proliferation index, and the presence of abnormal multipotent stem cells.