Possible involvement of neuropeptide and neurotransmitter receptors in Adenomyosis

Xiaofang Xu, Xianjun Cai, Xishi Liu, Sun‐Wei Guo
Reproductive biology and endocrinology : RB&E · 2021 · vol. 19(1) , pp. 25 · doi:10.1186/s12958-021-00711-6 · PMID:33602248 · PMC7893711 · W3133403088
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

Adenomyotic lesions showed increased NK1R, CRLR, RAMP1, and ADRB2 receptor expression and decreased α7nAChR expression compared to control endometrium.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

The study compared adenomyotic tissue from 30 women with adenomyosis to age- and menstrual-phase–matched control endometrial tissue from 24 women without adenomyosis, using immunohistochemistry to measure receptor immunoreactivity for neuropeptide/neurotransmitter pathways (RAMP1/CRLR for CGRP, NK1R for substance P, ADRB2 for noradrenaline) and α7 nicotinic acetylcholine receptor (α7nAChR), with fibrosis assessed by Masson trichrome staining and symptom data including dysmenorrhea. Staining levels of NK1R, CRLR, RAMP1, and ADRB2 were significantly elevated in adenomyotic lesions, while α7nAChR staining was significantly reduced, and dysmenorrhea severity correlated positively with lesional ADRB2 levels. The authors interpret these patterns as consistent with SP, CGRP, and noradrenaline promoting adenomyosis and acetylcholine potentially counteracting it, with a proposed feed-forward loop involving pain and lesion progression via ADRB2/HPA-SAM axes. A key limitation is that the work is based on receptor immunohistochemistry and correlations, without direct functional assays or mechanistic validation. This paper is centrally about adenomyosis—identifying altered expression of neuropeptide/neurotransmitter receptors in adenomyotic lesions that parallels known mechanisms in endometriosis.

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Abstract

BACKGROUND: Accumulating data indicate that sensory nerve derived neuropeptides such as substance P and calcitonin gene related-protein (CGRP) can accelerate the progression of endometriosis via their respective receptors, so can agonists to their respective receptors receptor 1 (NK1R), receptor activity modifying protein 1 (RAMP-1) and calcitonin receptor-like receptor (CRLR). Adrenergic β2 receptor (ADRB2) agonists also can facilitate lesional progression. In contrast, women with endometriosis appear to have depressed vagal activity, concordant with reduced expression of α7 nicotinic acetylcholine receptor (α7nAChR). The roles of these receptors in adenomyosis are completely unknown. METHODS: Adenomyotic tissue samples from 30 women with adenomyosis and control endometrial tissue samples from 24 women without adenomyosis were collected and subjected to immunohistochemistry analysis of RAMP1, CRLR, NK1R, ADRB2 and α7nAChR, along with their demographic and clinical information. The extent of tissue fibrosis was evaluated by Masson trichrome staining. RESULTS: We found that the staining levels of NK1R, CRLR, RAMP1 and ADRB2 were all significantly elevated in adenomyotic lesions as compared with control endometrium. In contrast, α7nAChR staining levels were significantly reduced. The severity of dysmenorrhea correlated positively with lesional ADRB2 staining levels. CONCLUSIONS: Our results suggest that SP, CGRP and noradrenaline may promote, while acetylcholine may stall, the progression of adenomyosis through their respective receptors on adenomyotic lesions. Additionally, through the activation of the hypothalamic-pituitary-adrenal (HPA)-sympatho-adrenal-medullary (SAM) axes and the lesional overexpression of ADRB2, adenomyosis-associated dysmenorrhea and adenomyotic lesions may be mutually promotional, forming a viscous feed-forward cycle.

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Condition tags

endometriosisadenomyosisdysmenorrhea

MeSH descriptors

Adenomyosis Neuropeptides Receptors, Neurotransmitter Adenomyosis Adenomyosis Adenomyosis Adult alpha7 Nicotinic Acetylcholine Receptor alpha7 Nicotinic Acetylcholine Receptor Calcitonin Receptor-Like Protein Calcitonin Receptor-Like Protein Case-Control Studies China Endometrium Endometrium Endometrium Female Humans Middle Aged Neuropeptides

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