The bimodal role of matrix metalloproteinases and their inhibitors in etiology and pathogenesis of endometriosis (Review)

Magdalenia Bałkowiec, Radosław B Maksym, Radosław Maksym, Paweł K Włodarski, Paweł Włodarski
Molecular medicine reports · 2018 · vol. 18(3) , pp. 3123–3136 · doi:10.3892/mmr.2018.9303 · PMID:30066912 · PMC6102659 · W2883005469
review OA: gold CC0 ⤵ 44 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This review examines the dual role of matrix metalloproteinases and their inhibitors in endometrial tissue remodeling, covering their physiological functions, involvement in endometriosis pathogenesis, and potential therapeutic targeting.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-09 ⓘ

This review examines how dysregulated matrix metalloproteinases (MMPs) and their inhibitors (including TIMPs and RECK) contribute to extracellular matrix remodeling in the endometrial cycle and to the implantation, adhesion formation, and invasive growth of ectopic endometrial tissue. It synthesizes evidence that MMP activity is normally balanced for physiological tissue remodeling, but that altered MMP/TIMP regulation—shaped by steroid hormones (estrogen, progestins), cytokines (e.g., IL-1α, IL-4, IL-8), immune factors, and growth regulators—can promote endometriosis-like invasion, with similar mechanisms discussed alongside roles in cancer metastasis. The paper acknowledges that endometriosis etiology is multifactorial and that retrograde menstruation alone does not explain disease occurrence, and it notes that while multiple non-steroid endocrine modulators are supported in animal models, no clinical trials confirm their human effectiveness. This paper is centrally about endometriosis — it reviews MMPs and their inhibitors in endometriosis etiology and pathogenesis.

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Abstract

Aberrant regulation of matrix metalloproteinases (MMPs) may be the primary cause of endometrial lesion formation in a group of predisposed women. Prospect for the genuine origin of endometriosis is ongoing, since retrograde menstruation leads to presence of endometrial debris in peritoneal cavity of many women, which do not experience endometriosis. Tissue remodeling is regulated precisely by a balance of MMPs and their inhibitors. Interplay between factors enhancing and suppressing matrix turnover is crucial for cyclic preparation of endometrium for embryo implantation, and endometrial shedding and renewal in physiology of primates. Disorders of the regulation of matrix remodeling leads to augmentation of implantation and invasive growth of ectopic endometrial tissue. Moreover, endometriosis‑induced changes in the matrix balance leads to adhesion formation, ovulatory dysfunction and fertility impairment. The review summarizes the current knowledge regarding the regulation of extracellular matrix turnover in the physiology of the endometrial cycle and in the development of endometriosis, as well as the pathophysiology of ovulatory dysfunction in endometriotic women. Therapeutic modalities utilizing modulation of tissue remodeling were discussed.

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Endometriosis Endometrium Matrix Metalloproteinases Animals Endometriosis Endometriosis Endometriosis Endometrium Endometrium Enzyme Activation Female Humans Matrix Metalloproteinases Matrix Metalloproteinases Matrix Metalloproteinases Matrix Metalloproteinases Polymorphism, Genetic Protein Interaction Maps Tissue Inhibitor of Metalloproteinases

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Cited by (44)

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