Новые возможности применения α-SMA – биомаркера ранней стадии фиброза при хроническом эндометрите у больных с эндометриозом

Objective. To determine the presence of endometrial myofibroblasts (EM) in the endometrium as an indicator of early fibrogenesis in chronic endometritis by an immunohistochemical method using antibodies to smooth muscle α-SMA actin. Materials and methods. The study included 65 patients: 44 patients with histologically confirmed chronic endometritis and external genital endometriosis, and endometriomas of the ovaries. Control group – 21 patients – healthy women, examined before IVF with the presence of a male factor of infertility. The material for the study was obtained by the method of pin-biopsy or biopsy with hysteroscopy. For histological examination, scrapings were fixed in 10% neutral buffered formalin, tissue was treated through a series of isopropanol alcohol in a LeicaASP 200 machine, with hematoxylin and eosin staining. The immunohistochemical study was performed using the Novolink polymer system and α-SMA monoclonal antibodies (clone1A4) from DAKO in an automated manner in a BondmaxLeica machine. Statistical software 10.1 was used for static analysis of the obtained data. Results . In the unmodified, functioning endometrium in the proliferative and early secretory phases of the menstrual cycle in women of the control group, α-SMA is determined in the walls of the vessels, which emphasizes their typical connective tissue and smooth muscle structure and is not contained in the luminal and glandular epithelium, is not defined in the stroma in the form intercellular expression. In chronic endometritis, α-SMA expression was detected in the endometrial stroma as a different combination of cellular and intercellular expression variants. In the endometrium, the diffusive-branching network of α-SMA-positive fibroblast fibers was determined both in the stroma and in the periglandulary and perivascular zones. Correlation analysis showed a reverse significant statistically significant relationship between EM and intercellular deposition of the fibrous-fibrous α-SMA network (Spearman coefficient -0,60, p<0,001). In the group of women with chronic endometrium, in contrast to the control group, EM spindle-shaped forms with an elongated process cytoplasm and less rounded shape were reliably determined. In 10 patients with chronic endometritis with moderate intercellular expression (2 points), α-SMA expression was observed in the pericyte of vessels and in epithelial cells of glandular basal membranes. Conclusion. The determination of EM in the endometrium, their number and different relationship in the stroma allows to differentiate the early stage of fibrosis. Thus, α-SMA is a reliable indicator of endometrial myofibroblasts. The sensitivity of the IHC method for identifying endometrial myofibroblasts and determining the early stage of fibrogenesis is significantly higher in comparison with the histological method.