Human Reproduction, Vol 13, 1686-1690, Copyright © 1998 by Oxford University Press
J Donnez, P Smoes, S Gillerot, F Casanas-Roux and M Nisolle
Angiogenesis is likely to be involved in the pathogenesis of endometriosis.
According to the transplantation theory, when the exfoliated endometrium is
attached to the peritoneal layer, the establishment of a new blood supply
is essential for the survival of the endometrial implant and development of
endometriosis. From the known angiogenic factors, vascular endothelial
growth factor (VEGF) has emerged as a pivotally important regulator of
normal angiogenesis and pathological neovascularization. The VEGF protein
was evaluated immunohistochemically in the eutopic endometrium of 10 women
without endometriosis (group I) at laparoscopy and the eutopic endometrium
and peritoneal endometriotic lesions of 43 women with endometriosis (group
II). VEGF histological scores were 9.7 +/- 4.3 and 4.0 +/- 2.6 respectively
in the epithelium and stroma of the eutopic endometrium of group I women,
and 10.3 +/- 2.3 and 3.6 +/- 2.3 respectively in women of group II. In red
lesions, the VEGF scores were 11.1 +/- 3.0 in the epithelium and 5.1 +/-
3.0 in the stroma, and in black lesions were 8.6 +/- 2.7 and 1.6 +/- 1.6,
respectively. Significantly lower values were observed in black lesions as
compared with eutopic endometrium and red lesions, the values of which were
similar. Scores were also evaluated according to the phase of the cycle. In
eutopic as well as ectopic endometrium, no significant cyclic variations
were observed throughout the cycle. However, VEGF content was found to be
higher in the eutopic glandular epithelium of women with endometriosis
during the late secretory phase, possibly suggesting a more likely tendency
to implant. In contrast, significantly higher VEGF content was noted in red
lesions as compared with black lesions. During all phases of the cycle, the
VEGF content in stromal cells of red lesions was higher than in black
lesions. Similarities in VEGF content were observed in the glandular
epithelium of the eutopic endometrium of women with endometriosis and red
lesions, suggesting that endometriosis probably arises from the peritoneal
seeding of viable endometrial cells during retrograde menstruation and that
red lesions can be considered as the first stage of implantation. After the
attachment phase, the high VEGF levels could provoke an increase in the
subperitoneal vascular network and facilitate implantation and viability in
the retroperitoneal space. Lower VEGF levels in black lesions explain the
decrease in both stromal vascularization, followed by fibrosis and
inactivation of the implant.
ARTICLES
Vascular endothelial growth factor (VEGF) in endometriosis
Department of Gynaecology, St Luc's University Hospital, Brussels, Belgium.
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