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，导致疼痛、不孕和 美国每年与医疗保健相关的成本高达数十亿美元。与一种鲜为人知的 病因学上，子宫内膜异位症的特点是对激素有反应的子宫内膜植入 在子宫外。来自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物可能会 在子宫内膜异位症的病因和严重程度中起作用。我们建议量九号 全氟烷基物质和53种持久性有机污染物 人群广泛暴露在在位(健康子宫组织)和异位。 (子宫内膜异位症植入物)子宫内膜组织。这部文学作品的局限性在于没有 子宫内膜异位症的发病率和严重程度与PFASs、POPS及其相互关系的研究 在子宫组织中测量的混合物。这项研究利用了一种独特的生物储存库 收集自子宫内膜异位症的操作队列：自然病史、诊断、 NICHD的一项研究，招募了495名年龄在18-44岁的女性 来自加利福尼亚州和犹他州的14个临床中心。我们会 确定：1)在位时是否存在较高水平的全氟辛烷磺酸、持久性有机污染物及其混合物 子宫内膜组织与发生的子宫内膜异位症有什么关系？2)这些 异位内膜组织暴露与子宫内膜异位症严重程度相关；3) PFASs和POPS的混合物是否跨越血清、脂肪组织和在位 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能 获取子宫内膜组织，我们将开发一个模型来预测在位内膜剂量 从血清全氟辛烷磺酸水平和持久性有机污染物暴露。这项研究将提供以下关键数据 全氟辛烷磺酸和持久性有机污染物，这将促进科学理解并为政策提供信息 制造者。

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.