Epithelial-Dominant Cell-Cell Communication and Endometriosis

女性暴露于雌激素是子宫内膜异位症发生的主要内分泌危险因素 而怀孕期间暴露于孕酮是这种疾病的负面风险因素。 然而，最近的证据表明，子宫内膜对孕酮敏感性的降低可能代表了子宫内膜对孕酮敏感性的降低。 可能是整个疾病过程中的重要因素。为了确定 降低子宫内膜对孕酮的反应性， 已经集中在孕酮下调基质金属蛋白酶表达的失败上， (MMP)系统在分泌成熟。建立异位妊娠所需的侵入性事件 子宫内膜生长涉及腹膜腔内细胞外基质的分解。的失败 雌激素下调子宫内膜异位症患者子宫内膜关键基质金属蛋白酶的表达， 子宫内膜异位症嵌合人/裸鼠模型中其组织的侵袭能力。我们假设 在子宫内膜异位症患者中，孕酮反应性降低会损害细胞-细胞 在在位子宫内膜内分泌成熟期间的通信。孕酮减少 特异性干扰关键转化生长因子-β（TGF-β）的表达 导致上皮主导的细胞-细胞通讯模式的信号蛋白。上皮显性的 细胞间通讯可增加MMP的表达， 子宫内膜碎片迅速侵入腹膜表面，获得血管并建立 子宫内膜异位症为了验证我们的假设，我们提出了三个具体目标：1）确定 基质细胞中PR同种型表达和/或TGF-β信号传导的破坏是否与 孕酮下调MMP-3和MMP-7在子宫内膜异位症患者在位内膜中的表达 子宫内膜异位症，并确定是否手术减少异位疾病与或不孕激素治疗 恢复正常的MMP调节2），以确定是否降低孕酮敏感性， 子宫内膜异位症妇女的子宫内膜对间质生长期间维甲酸的合成有负面影响 蜕膜化3）以确定体外上皮主导细胞-细胞通讯的功能影响 以及在体内实验性子宫内膜异位症的侵入性建立期间。

A woman's exposure to estrogen represents her principal endocrine risk factor for developing endometriosis while exposure to progesterone during pregnancy represents a negative risk factor for this disease. However, recent evidence suggests that reduced endometrial sensitivity to progesterone may represent a potentially important element in the overall disease process. In an attempt to identify the consequences of reduced endometrial responsiveness to progesterone on the basic pathophysiology of endometriosis, we have focused on the failure of progesterone to down-regulate the expression of the matrix metalloproteinase (MMP) system during secretory maturation. The invasive events required for the establishment of ectopic endometrial growth involves the breakdown of extracellular matrix within the peritoneal cavity. The failure of progesteone to down-regulate endometrial expression of key MMPs in endometriosis patients increases the invasive capacity of their tissue in a chimeric human/nude mouse model of endometriosis. We hypothesize that, in women with endometriosis, reduced progesterone responsiveness compromises cell-cell communication during secretory maturation within the eutopic endometrium. Reduced progesterone responsiveness specifically disrupts the expression of key transforming growth factor-p (TGF-P) signaling proteins leading to an epithelial-dominant pattern of cell-cell communication. Epithelialdominant cell-cell communication acts to increase MMP expression and promote the ability of endometrial fragments to rapidly invade the peritoneal surface, acquire a vasculature and establish the disease endometriosis. To test our hypothesis, we propose three Specific Aims: 1) to determine whether disruption of PR isotype expression in stromal cells and/or TGF-(3 signaling is linked to .the failure of progesterone to down-regulate MMP-3 and MMP-7 expression in the eutopic endometium of women with endometriosis and to determine if surgical reduction of ectopic disease with or without progesterone therapy restores normal MMP regulation 2) to determine whether reduced progesterone sensitivity in the endometrium of women with endometriosis negatively affects the synthesis of retinoic acid during stromal decidualization 3) to determine the functional impact of epithelial-dominant cell-cell communication in vitro and during the invasive establishment of experimental endometriosis in vivo.