Diagnosis and Treatment of Endometriosis: A Translational Approach

子宫内膜异位症的诊断和治疗：一种转化方法 摘要 开发子宫内膜异位症诊断和治疗方法的合作中心， 总体目标是开发先进的工具和见解， 子宫内膜异位症的病理生理学我们追求这一目标，以提高诊断，评估和治疗 患有这种常见的毁灭性疾病的妇女。病因学研究进展 子宫内膜异位症的病理生理学已被疾病评估的局限性显著削弱， 目前的治疗方法防止生育并且效果最低。对外科手术的依赖 评估延迟诊断，限制临床医生和研究人员确认子宫内膜异位症病变 复发或对治疗的反应。因此，需要一个更好的范例来科学地解决这种疾病。 慢性炎症是不孕症和疼痛的基础。当炎症消退时 需要专门的促消退介质（SPM），包括花生四烯酸衍生物 酸，二十碳五烯酸和二十二碳六烯酸，这些介质还没有被仔细检查， 女性子宫内膜异位症一些SPM需要SIRT 1，这是一种组蛋白脱乙酰酶， 许多疾病的进程，并在子宫内膜异位症个体的在位子宫内膜中过度表达， 人、狒狒、恒河猴和小鼠子宫内膜。然而，炎症持续存在， 子宫内膜异位症，这表明SPMresolving活性的SIRT 1诱导受到损害。我们的初步数据 表明受体表达的变化导致从抗炎到促炎作用的转变 的SPM。因此，SIRT 1和SPM可能是子宫内膜异位症的新治疗靶点。 我们的具体目标是解决子宫内膜异位症诊断和治疗的差距如下： 在目标1中，我们通过改进一种新的成像技术来解决诊断问题， 子宫内膜异位症病灶和相关炎症中类固醇激素的表达：我们建议 使用基于孕激素的示踪剂21-[18F]氟-呋喃基-去甲-孕酮（FFNP）用于正电子 发射断层扫描（PET）联合同步钆（Gd）造影剂，磁共振成像 （GMRI），以允许子宫内膜异位症病变的解剖定位和突出炎症区域。 在目标2中，我们通过研究为什么与糖尿病相关的炎症是 SPM未解决，包括SIRT 1翻译后修饰和SPM表达的评价 子宫内膜异位症妇女和非子宫内膜异位症妇女的生物合成酶和受体;以及这些酶和受体之间的相关性。 参数与人类和非人类灵长类动物组织中的炎症和代谢改变。 该项目与项目2（Jeong和Lessey）和项目3（Slayden）具有明显的协同作用， 人类、非人灵长类动物和小鼠模型之间的跨物种和跨模型比较， 比较基因组学与生物信息学（Comparative Genomics and Bioinformatics，CGB）

Project 1 (Young) Diagnosis and Treatment of Endometriosis: A Translational Approach ABSTRACT The Collaborative Center to Develop Improved Diagnostic and Therapeutic Approaches to Endometriosis has the overarching goal of developing advanced tools and insights for improved understanding of the pathophysiology of endometriosis. We pursue this goal to enhance the diagnosis, assessment, and treatment of women suffering from this common and devastating disease. Progress in understanding the etiology and pathophysiology of endometriosis has been significantly compromised by limits to disease assessment, and current therapeutic approaches prevent fertility and are minimally effective. The dependence on surgical assessment delays diagnosis and limits clinicians and researchers from confirming endometriosis lesion recurrence or response to therapies. Thus, a better paradigm is needed to scientifically address this disorder. Chronic inflammation underlies both infertility and pain in the disease. While resolution of inflammation throughout the body requires specialized pro-resolving mediators (SPMs), including derivatives of arachidonic acid, eicosapentaenoic acid, and docosahexaenoic acid, these mediators have not been closely examined in women with endometriosis. Some SPMs require SIRT1, a histone deacetylase that epigenetically regulates many disease processes and is overexpressed in the eutopic endometrium of individuals with endometriosis in humans, baboons, rhesus macaques, and mouse endometrium. However, inflammation persists in endometriosis, suggesting that SIRT1 induction of SPM resolving activity is compromised. Our preliminary data indicate that a change in receptor expression results in a shift from anti-inflammatory to pro-inflammatory actions of SPMs. Therefore, SIRT1 and SPMs may represent novel therapeutic targets for endometriosis. Our specific aims address the gaps in endometriosis diagnosis and therapy as follows: In Aim 1, we approach the problem of diagnosis by refining a novel imaging technique that takes advantage of both steroid hormone expression in endometriosis lesions and the associated inflammation: we propose imaging endometriosis using a progestin-based tracer 21-[18F]fluoro-furanyl-nor-progesterone (FFNP) for positron emission tomography (PET) combined with simultaneous gadolinium(Gd)-contrast, magnetic resonance imaging (GMRI), to allow anatomic localization of endometriosis lesions and highlight areas of inflammation. In Aim 2, we directly address the issue of treatment by investigating why endometriosis-related inflammation is not resolved by SPMs, including evaluation of post-translational modifications of SIRT1 and expression of SPM biosynthetic enzymes and receptors in women with and without endometriosis; and the correlation of these parameters with inflammation and metabolic alterations in human and non-human primate tissue. This project exhibits clear synergy with both Project 2 (Jeong and Lessey) and Project 3 (Slayden) and provides cross-species and cross-model comparisons between humans, nonhuman primates, and mouse models, aided by the Comparative Genomics and Bioinformatics (CGB) Core.