Investigating Mixtures of Pollutants and Endometriosis in Tissue (IMPLANT) Study

摘要 子宫内膜异位症影响6-11%的绝经前妇女，引起疼痛，不孕， 美国每年花费数十亿美元用于医疗保健。与一个鲜为人知的 病因学，子宫内膜异位症的特点是子宫内膜种植体的反应 在子宫外。实验和人体研究的证据表明， 人类几乎无处不在地接触到的内分泌干扰化学物质， 在子宫内膜异位症的病因和严重程度中发挥作用。我们建议采取九项措施 全氟烷基物质和53种持久性有机污染物， 人群广泛暴露于在位（健康子宫组织）和异位 （子宫内膜异位植入物）子宫内膜组织。文献是有限的，因为没有 子宫内膜异位症发病率和严重程度与PFAS、POP及其 在子宫组织中测量的混合物。这项研究利用了一个独特的生物储存库， 收集自子宫内膜异位症的手术队列：自然史，诊断， ENDO研究，一项NICHD研究，招募了495名年龄在18-44岁的女性 来自加州和犹他州的14个临床中心的患者。我们将 确定：1）是否较高水平的PFASs，持久性有机污染物，及其混合物， 子宫内膜组织与子宫内膜异位症有关，2）这些组织如何与子宫内膜异位症有关， 异位子宫内膜组织中的暴露与子宫内膜异位症的严重程度相关; 3） PFAS和持久性有机污染物的混合物是否在血清、脂肪组织和原位 子宫内膜组织，与子宫内膜异位症的发病率有关;最后，4） 认识到大多数妇科疾病的流行病学研究不可行， 获得子宫内膜组织，我们将开发一个模型来预测在位子宫内膜剂量 血清中PFAS和POP的含量这项研究将提供关键数据， 全氟辛烷磺酸和持久性有机污染物，这将促进科学认识并为政策提供信息 创客

ABSTRACT Endometriosis affects 6-11% of premenopausal women, causing pain, infertility, and billions of dollars in U.S. health care related costs annually. With a poorly understood etiology, endometriosis is characterized by hormonally responsive endometrial implants outside the uterus. Evidence from experimental and human studies indicate that endocrine disrupting chemicals, to which humans are nearly ubiquitously exposed, may play a role in endometriosis etiology and severity. We propose to measure nine perfluoroalkyl substances (PFASs) and 53 persistent organic pollutants (POPs) to which the population is broadly exposed, in eutopic (healthy uterine tissue) and ectopic (endometriosis implants) endometrial tissue. The literature is limited in that there are no studies of endometriosis incidence and severity in relation to PFASs, POPs, and their mixtures measured in uterine tissue. This study leverages a unique biorepository collected from the operative cohort of the Endometriosis: Natural History, Diagnosis, and Outcomes (ENDO) Study, an NICHD study which enrolled 495 women aged 18-44 from 14 clinical centers in California and Utah prior to laparoscopic surgery. We will determine: 1) whether higher levels of PFASs, POPs, and their mixtures in eutopic endometrial tissue are associated with incident endometriosis and 2) how these exposures in ectopic endometrial tissue are associated with endometriosis severity; 3) whether mixtures of PFASs and POPs across serum, adipose tissue, and eutopic endometrial tissue, are associated with endometriosis incidence; and finally, 4) recognizing the infeasibility of most epidemiologic studies of gynecologic disease to obtain endometrial tissue, we will develop a model to predict eutopic endometrial dose from serum levels of PFAS and POP exposure. This study will provide critical data on PFASs and POPs, which will advance scientific understanding and inform policy makers.